Closed reduction by trans-physealantegrade elastic stable intramedullary nailing in acute pediatric Monteggia fractures

Background: Pediatric forearm bone fracture present significant challenges where most of them are managed with closed reduction and casting. Irreducible, unstable and open fracture usually requires operative stabilization. Intramedullary nailing is considered minimal invasive however it is not free of complication. The aim of this study is to analyze the outcome and complications after elastic stable intramedullary nailing in pediatric diaphyseal forearm fracture.Methods: A descriptive observational study was carried out for four years (2013-2016) in diaphyseal pediatric forearm fracture stabilized with titanium elastic stable intramedullary nailing. Final range of motion, complications and outcome were assessed using Clavien-Dindo classification modification appropriate for orthopedic surgery.Results: We report the outcome of 36 patients with complete medical records. Closed reduction and nailing was successful in 25 patients (69.4%) whereas eleven patients (30.6%) required open reduction (both radius and ulna in 6 patients 16.7%, ulna in 3 patients 8.3% and radius in 2 patients 5.6%). Radiological union was achieved at an average of 7.75±1.5 weeks (range 6 to 16 weeks). Forearm rotation was limited in 7 patients with average loss of 16° pronation and 18° supination. The overall rate of complication was 22.2%. According to Clavien-Dindo classification excellent results were noted in 29 patients (80.6%), good in 3 patients (8.3%) and fair in 4 patients (11.1%). Conclusions: Elastic intramedullary nailing in pediatric diaphyseal forearm bones fracture is minimally invasive with low rate of complication and the outcomes are fair to excellent.

Download Full-text

Antegrade elastic stable intramedullary nailing in treatment of irreducible distal radius fractures in diaphyseal-metaphyseal junction in children

10.21203/rs.3.rs-18142/v1 ◽

2020 ◽

Author(s):

Weifeng Lin ◽

Shuai Liu ◽

Taotao Hui

Keyword(s):

Intramedullary Nailing ◽

Distal Radius ◽

Closed Reduction ◽

Statistical Significance ◽

Minimal Invasive ◽

Elastic Stable Intramedullary Nailing ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fractures In Children

Abstract Purpose This paper aimed to study the method and outcome of antegrade elastic stable intramedullary nailing (ESIN) for irreducible distal radius fractures in diaphyseal-metaphyseal junction in children. Methods 27 irreducible distal radius fractures in children ranging in age from six to 13 years treated with closed reduction and antegrade ESIN from March 2017 to September 2018 were analyzed retrospectively. The series comprised 24 boys and three girls. 17 cases were double fractures in forearms and ten cases were single fractures of radius. Each case was treated with closed reduction, internal fixation of antegrade ESIN and plaster cast. ESIN was removed when fracture healed and remodelled well. Cooney modified Green-O'Brien wrist score was used to evaluate the wrist function. Ranges of motion (ROM) in bilateral wrists were contrasted at the final follow-up. P<0.05 was considered statistically significant in the difference. Results All the fractures healed four to six weeks post-operative. At the final follow-up (12-16 months), there was no statistical significance in ROM of bilateral wrists (all p>0.05). The mean Cooney modified Green-O'Brien wrist score was 93 (80-100) including 25 excellent (93%) and two good (7%) results. Conclusions The technique of antegrade ESIN is effective and minimal invasive for irreducible distal radius fractures in children. The criterion of proximal radius approach to implant ESIN should be studied further in minimal invasive therapy of fractures.

Download Full-text

COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v2i6.38 ◽

2018 ◽

Author(s):

Anil Pandey ◽

Setul Shah ◽

Deepak S Maravi ◽

S Uikey

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Proximal Tibia ◽

Plate Fixation ◽

Surgical Site Infections ◽

Delayed Union ◽

Large Sample Size ◽

Multicentric Study ◽

Group A ◽

Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

Download Full-text

Double Fibular Fracture: An Innovative Use for Elastic Stable Intramedullary Nailing of a Distal and Proximal Fibular Fracture

Foot & Ankle Surgery: Techniques, Reports & Cases ◽

10.1016/j.fastrc.2021.100019 ◽

2021 ◽

pp. 100019

Author(s):

Duane J. Ehredt ◽

Lauren L. Schnack ◽

Yasmin Radzi

Keyword(s):

Intramedullary Nailing ◽

Elastic Stable Intramedullary Nailing ◽

Fibular Fracture

Download Full-text

Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: An Unusual Case and Review of the Literature

Case Reports in Medicine ◽

10.1155/2011/682454 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Surjit Lidder ◽

Nima Heidari ◽

Florian Amerstorfer ◽

Stephan Grechenig ◽

Annelie M. Weinberg

Keyword(s):

Median Nerve ◽

Intramedullary Nailing ◽

Radial Head ◽

Nerve Palsy ◽

Unusual Case ◽

Elastic Stable Intramedullary Nailing ◽

Monteggia Fracture ◽

Type I ◽

Monteggia Lesion ◽

Median Nerve Palsy

Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.

Download Full-text

The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

10.21203/rs.3.rs-26674/v2 ◽

2020 ◽

Author(s):

Zhaofeng Jia ◽

Shijin Wang ◽

Tinghui Xiao ◽

Wei Jiang ◽

Tianjian Zhou ◽

...

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Lateral Displacement ◽

Femoral Fractures ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Bony Union ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Displacements

Abstract Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

Download Full-text

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

Journal of Lumbini Medical College ◽

10.22502/jlmc.v4i1.82 ◽

2016 ◽

Vol 4 (1) ◽

pp. 11

Author(s):

Sandeep Gurung ◽

Dipendra KC ◽

Roshni Khatri

Keyword(s):

Intramedullary Nailing ◽

Demographic Data ◽

Elastic Stable Intramedullary Nailing ◽

Tibial Shaft ◽

Elastic Stable Intramedullary Nail ◽

Shaft Fractures ◽

Tibia Fractures ◽

One Year ◽

Skeletally Immature Patient ◽

Tibial Shaft Fractures

Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks (SD=2.65) for close and 14.3 weeks (SD=2.62) for open fracture. There were no instances of growth arrest, remanipulations, or refracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

Download Full-text

Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193592 ◽

2019 ◽

Vol 5 (5) ◽

pp. 816

Author(s):

A. Sandeep ◽

Jayant Jain

Keyword(s):

Intramedullary Nailing ◽

Complication Rate ◽

Bone Fractures ◽

Full Range ◽

Elastic Stable Intramedullary Nailing ◽

Long Bone ◽

Ankle Motion ◽

Soft Tissue Envelope ◽

Internal Support ◽

Diaphyseal Fractures

Background: Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.Methods: This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.Results: Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.Conclusions: Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.

Download Full-text