ATTRITIONAL RUPTURE OF EXTENSOR POLLICIS LONGUS: A RARE COMPLICATION FOLLOWING ELASTIC STABLE INTRAMEDULLARY NAILING OF A PAEDIATRIC RADIAL FRACTURE

Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

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Functional outcome of elastic stable intramedullary nailing of diaphyseal fractures of paediatric long bones

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164169 ◽

2016 ◽

Vol 2 (4) ◽

pp. 359

Author(s):

Arun Vashisht ◽

Gaurav Dev Sharma

Keyword(s):

Conservative Treatment ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Weight Bearing ◽

Elastic Stable Intramedullary Nailing ◽

Personal Hygiene ◽

Long Bones ◽

Forearm Bones ◽

Diaphyseal Fractures ◽

Partial Weight

Background: After the advent of titanium elastic nails (TENs) and gratifying results of elastic stable intramedullary nailing (ESIN) in diaphyseal fractures of paediatric long bones, not only the parents of patients are opting surgical treatment over conservative, but also more and more orthopaedicians are offering ESIN with TENs to obviate the inherent problems of conservative treatment. We took up this study to evaluate the functional outcome of ESIN with TENs.Methods: 44 patients aged 5-15 years suffering from diaphyseal fractures of femur, tibia, humerus, and forearm bones were treated by ESIN with TENs.Results: All 44 patients showed uneventful union, femur in an average period of 8.3 weeks, tibia in 7.3 weeks, forearm bones within 7 weeks and humerus in 7.5 weeks. Commonest complication was pain at insertion site. 1 femur patient had lengthening of 1.5 cm. 1 femur and 1 forearm patient showed joint stiffness. No patient had delayed/non-union, sagittal/coronal/rotational mal-union, and deep infection. Partial weight bearing (PWB) started from 2nd/3rd day attaining full weight bearing (FWB) in 6-10 weeks. Conclusions: ESIN with TENs appears logical and safe to obviate the inherent problems of conservative treatment, as ESIN is least invasive and allows early PWB/FWB leading to early independence of personal hygiene/toilet use with early social integration/return to school.

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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.

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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.

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Assessing leg length discrepancy following elastic stable intramedullary nailing for paediatric femoral diaphyseal fractures

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-006-0251-1 ◽

2007 ◽

Vol 127 (5) ◽

pp. 325-330 ◽

Cited By ~ 6

Author(s):

J. Mutimer ◽

R. D. Hammett ◽

J. D. Eldridge

Keyword(s):

Intramedullary Nailing ◽

Elastic Stable Intramedullary Nailing ◽

Leg Length Discrepancy ◽

Leg Length ◽

Length Discrepancy ◽

Diaphyseal Fractures

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Elastic stable intramedullary nailing in pediatric diaphyseal forearm bone fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170455 ◽

2017 ◽

Vol 3 (2) ◽

pp. 190

Author(s):

Poojan Kumar Rokaya ◽

Mangal Rawal ◽

Javed Ahmad Khan ◽

Praveen Kumar Giri

Keyword(s):

Intramedullary Nailing ◽

Bone Fracture ◽

Closed Reduction ◽

Forearm Fracture ◽

Minimal Invasive ◽

Elastic Stable Intramedullary Nailing ◽

Forearm Bones ◽

Average Loss ◽

Forearm Bone ◽

Elastic Intramedullary Nailing

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.

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