scholarly journals Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates

2016 ◽  
Vol 3 (1) ◽  
pp. 80
Author(s):  
Angad Jolly ◽  
Neelanagowda V. Patil ◽  
Rahul Bansal ◽  
Veeresh Pattanshetti
Keyword(s):  
Knee Joint ◽  
Internal Fixation ◽  
Significant Loss ◽  
Fixation Method ◽  
Wound Complications ◽  
Angular Deformity ◽  
Femur Fractures ◽  
Diaphyseal Fractures ◽  
Elastic Nails ◽  
Compression Plating

<p class="abstract"><strong>Background:</strong> A variety of methods have been described for the management of femur diaphyseal fractures in children between ages of 5 to 12 years. Some of the techniques include closed reduction and internal fixation (CRIF) with elastic nails, open reduction and internal fixation (ORIF) with compression plates, external fixators and skeletal traction with spica casting. This study was done to compare the outcome and complications of diaphyseal femur fractures in pediatric age treated with CRIF with Titanium elastic nails vs. ORIF with compression plates<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The study was a prospective, clinical study.  A total of 60 patients were studied. 30 patients were treated with CRIF with titanium nails and 30 patients were treated with ORIF with compression plates. Every patient operated was followed up at 3 weeks, 6 weeks, 3 months, 6 months and 3 monthly thereafter until implant removal.<strong></strong></p><p class="abstract"><strong>Results:</strong> Only 1 wound healing complication was noted in the TENS nail group which was skin irritation at the site of pin insertion. In the compression plating group, 6 patients developed wound complications, including superficial infections, deep infections and keloids. The range of movements at knee joint in the two groups was compared.  Only 1 patient had a significant loss of flexion with ROM of less than 100 degrees in the TENS nail group. In the plating group 4 patients had a significant loss of flexion with ROM of less than 100 degrees. Limb length discrepancies were seen in 3 patients in the TENS nail group whereas the compression plating group showed 1 patient. 2 patients in the TENS group developed an angular deformity due to premature weight bearing.  3 patients in the compression plating group developed deformities at the fracture site. The average time for fracture union in the compression plate group was 10.7 weeks and was 14.7 weeks in the patients treated with TENS nail<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> No single fixation method can be considered superior in all types and patterns of pediatric diaphyseal femur fractures. Titanium elastic nails can be considered a better implant for treating pediatric femur fractures when compared to compression plates due to the lesser rates of surgical wound complications, better range of movements at knee joint and overall lesser complication rate as was recorded in this study<span lang="EN-IN">.</span></p>

scholarly journals Distal femoral complications following antegrade intramedullary nail placement

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Amanda J. Fantry ◽  
Gregory Elia ◽  
Brian G. Vopat ◽  
Alan H. Daniels
Keyword(s):  
Postoperative Complications ◽  
Knee Joint ◽  
Intramedullary Nailing ◽  
Case Series ◽  
Fixation Method ◽  
Radius Of Curvature ◽  
Careful Study ◽  
X Rays ◽  
Femur Fractures ◽  
Cortical Perforation

While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.

scholarly journals "Net cage" technique in the treatment of inferior pole patella fracture: a novel patella internal fixation technique

2021 ◽  
Author(s):  
Ming Li ◽  
Hongfei Qi ◽  
Teng Ma ◽  
Zhong Li ◽  
Cheng Ren ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Internal Fixation ◽  
Fracture Healing ◽  
Healing Time ◽  
Fixation Method ◽  
Inferior Pole ◽  
Functional Exercise ◽  
Net Cage

Abstract Objective Fractures of the inferior pole of the patella can cause the knee joint extensor mechanism disorder. The fracture fragments are usually small and comminuted. Therefore, there are certain difficulties in fixation. The purpose of this study is to observe the effect of the "Net cage" technique in the treatment of the inferior pole of the patella. Methods This is a retrospective study that included 16 cases of inferior patella fractures (AO/OTA 34-A1) who underwent the "Net cage" technique from March 2017 to June 2020. Collecting their medical records and follow-up results, measuring indicators include the surgical complications of the fixation method, knee joint function, the number of fluoroscopies, fracture healing, and the incidence of soft tissue stimulation. Results The fractures of all patients healed smoothly, and there were no complications such as failure of internal fixation and fracture of implants. The average number of intraoperative fluoroscopy was 5.56 times (range: 4-10 times); the average fracture healing time was 10.5 weeks (range: 8-14 weeks) ). No patients reported internal fixation-related soft tissue irritation. At the last follow-up, the knee function showed that the average ROM was 133.75° (range: 120°~140°); The average Bostman score was 27.94 points (range: 24-30 points). Conclusion "Net cage" technology for the treatment of inferior pole fractures of the patella has the advantages of reduced fluoroscopy, fixation and stability, early functional exercise, and better knee joints after surgery.

ASSESSMENT OF RESULTS OF TREATMENT OF PAEDIATRIC FEMORAL DIAPHYSEAL FRACTURES WITH TITANIUM ELASTIC NAILS

2021 ◽  
pp. 75-76
Author(s):  
Shamir Rahman ◽  
Nafees Fatima ◽  
Vijay Kumar ◽  
Debarshi Jana
Keyword(s):  
Femoral Fractures ◽  
Control Group ◽  
Age Group ◽  
Femur Fractures ◽  
Results Of Treatment ◽  
Operative Evaluation ◽  
Diaphyseal Fractures ◽  
Elastic Nails ◽  
Surgical Modality ◽  
Distal Fracture

Introduction: Femoral fractures are among the most common fractures of long bones. The management of pediatric femur fractures depends basically on the age group of the child although the age of bone and size of the child also determines the treatment choice. The choice of management may also be determined by surgical experience and local trends in practice. Study aimed to assess the results of treatment of paediatric femoral diaphyseal fractures with titanium elastic nails. Material And Methods: The study was conducted at Orthopaedics Department of PMCH, Patna, Bihar. A total of 22 patients with closed shaft femur fractures and age ranging between 5-16 years scheduled to undergo treatment with titanium elastic nails were selected for the study. Children with open fractures, outside this age group with concomitant head injury, bilateral femur fracture or associated fracture of either limb whose xation was done after 7 days were excluded from the study. No control group was used. They were treated by retrograde TENS xation using two nails of equal diameter for each fracture. Pre-operative evaluation includes full length radiograph of the fractured femur both antero–posterior (A–P) and lateral views. Results: In the present study, 22 patients with closed shaft femur fractures were treated with titanium elastic nails. The mean age of the patient was 13.23 years. We observed that in regards to fracture location, proximal fracture was seen in 5 patients, midshaft fracture in 14 patients and distal fracture in 3 patients. However, in regards to pattern of location, transverse fracture was seen in 6 patients, oblique fracture in 8 patients, spiral fracture in 5 patients and comminuted fracture in 3 patients. Conclusion: From this study we can conclude that Intramedullary nailing of the pediatric femoral diaphyseal fractures using titanium elastic nail is an effective surgical modality, with advantages of minimal incisional scar, minimal soft tissue damage, with early union time and excellent union rates, and without affecting shoulder and elbow function.

scholarly journals (P1-105) Osteosynthesis of Children with Femur Fractures from Traffic Accidents

2011 ◽  
Vol 26 (S1) ◽  
pp. s133-s133
Author(s):  
V.M. Rozinov ◽  
S.I. Jandiev ◽  
V.I. Petlakh
Keyword(s):  
Traffic Accidents ◽  
Functional Results ◽  
Infectious Complications ◽  
Optimum Treatment ◽  
Number Of Children ◽  
Intramedullary Osteosynthesis ◽  
Femur Fractures ◽  
Fractures In Children ◽  
Diaphyseal Fractures ◽  
Elastic Nails

IntroductionThe growing number of children suffering polytrauma from traffic accidents dictates the expansion of the indications for osteosynthesis. Elastic-stable intramedullary osteosynthesis (ESIN) is the optimum treatment of fractures of long bones in children.MethodsClosed intramedullary osteosynthesis of diaphyseal femur fractures with flexible nails was performed in 74 patients (76 fractures) during 2006–2010. The patients were children ages 1–8 years. Titanium elastic nails (TEN) (Synthesis, Switzerland) were used in the procedures. AO Foundation recommendations were adhered to when selecting the size of the implant (i.e., diameter approximately 1/3 the diameter of the femur medullar canal at its narrowest part).ResultsThere was a prevalence (n = 53) of simple fractures (Ð3 by AO classification) in this group of patients. Sixteen children had Ð2-type fractures, five with spiral (Ð1), and two with slanting (Ð2) fractures. There were no type Ð1 or Ð3 complex fractures in this group. Good functional results of closed intramedullary osteosynthesis with TEN at diaphyseal fractures of the femur in children with isolated and associated damages were achieved. There were no post-operative complications. This method provided stability of osteosynthesis, which allows activating patients in the short- term, i.e., during the post-operative period.ConclusionTreating femur fractures in children with ESIN provides optimum treatment of polytrauma. Osteosynthesis without exposure to the area of damage, and the early activation of children can prevent infectious complications and contractures.

A COMPARATIVE STUDY TO DETERMINE THE KNEE JOINT FUNCTIONAL OUTCOME IN PATIENTS WITH FEMUR SHAFT FRACTURES MANAGED OPERATIVELY OR CONSEVATELY AT NDOLA HOSPITAL:complete enumeration (Preprint)

2019 ◽  
Author(s):  
Ripedah Nakana
Keyword(s):  
Knee Joint ◽  
Functional Outcome ◽  
Road Traffic ◽  
Femur Fracture ◽  
Conservative Group ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Femur Shaft ◽  
Femur Shaft Fractures

BACKGROUND According to WHO, It has been reported that there has been a rise in road traffic accidents globally due to many factors. Consequently this has contributed to an increase in fracture of the femur in hospitals. The annual incidence of these Fractures has been estimated to be 10 per 100,000 persons and this incidence has been noticed to be higher among the youths decreasing after the age of 40 and then increasing in the elderly. These fractures are either managed conservatively or operatively. OBJECTIVE the aim of this study was to determine if there is a significant difference in knee joint functional outcome in patients with femur shaft fractures managed operatively and conservatively at Ndola Teaching Hospital at the orthopedics clinic and physiotherapy. This in future might help to place emphasis on government to sensitize the right measures needed to improve on the functional outcome of a knee joint in patients with femur fracture who are treated operatively or conservatively METHODS the method used for the study was a complete enumeration of all patients with femur fractures that were admitted at orthopedic ward, visited the orthopedic clinic and physiotherapy sessions at NTH between the period of July 2019 to September 2019. Data collected will be analyzed using a statistical data software called Statistical Package of Social Sciences (SPSS). The independent variable that will be considered in the study are age, DOI, DOA, femur shaft fractures, treatment and others that that will meet the selection Criteria. The dependent variable will be “Knee Joint Functional Outcome”. RESULTS Results did not show statistically significant difference in knee functional outcome for two methods (conservative or operative). In the current study it was noted that there was much reduction in swelling in the operative in comparison to the conservative group. We may therefore conclude that the operative management promises a better outcome especially when done on time. However it seemed the operative procedure was not preferred for any conservative approach however the study has shown an in depth feasibility study to affirm such findings in order to inform on policy or management paradigim shift. CONCLUSIONS There is need for further intervention in the management of femur fracture which complicates to poor knee joint function

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 763
Author(s):  
Tiago Martinho ◽  
Karl Stoffel
Keyword(s):  
High Risk ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Bipolar Hemiarthroplasty ◽  
Intramedullary Nails ◽  
Fixation Failure ◽  
Femur Fractures

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

Arthroscopic Reduction and Internal Fixation (ARIF) of a Comminuted Posterior Talar Body Fracture: Surgical Technique and Case Report

2017 ◽  
Vol 10 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Rishin Kadakia ◽  
Jeff Konopka ◽  
Tristan Rodik ◽  
Samra Ahmed ◽  
Sameh A Labib
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Case Reports ◽  
Wound Complications ◽  
Open Approach ◽  
Arthroscopic Reduction ◽  
Body Fracture ◽  
Anatomic Reduction ◽  
Talar Body Fracture

The talus is the second most common fractured tarsal bone. While their incidence may be low, talus fractures are severe injuries that can lead to long-term disability and pain. Displaced talar body fractures are typically treated through an open approach with the aim of obtaining anatomic reduction and stable fixation. There are several case reports in the literature demonstrating successful management of talus fractures arthroscopically. An arthroscopic approach minimizes soft tissue trauma, which can help decrease postoperative wound complications and infections. In this article, the authors describe a surgical technique of an arthroscopic reduction and internal fixation of a comminuted posterior talar body fracture. Compared with an open posterior approach with or without osteotomies, an arthroscopic technique improved visualization and allowed precise reduction and fixation. Levels of Evidence: Level V: Case report

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