Prospective Study of Surgical Management of Diaphyseal Fractures of Both Bones Forearm in Older Children Using Titanium Elastic Intramedullary Nailing at a Tertiary Care Hospital in Srikakulam

BACKGROUND Diaphyseal fractures of the forearm are one of the common fractures in the paediatric population. Closed reduction and cast immobilisation remain the standard treatment for paediatric diaphyseal forearm fractures owing to their unique remodelling potential. The main concern of conservative management is re-displacement of fracture in cast resulting in the unacceptable angular deformity in the forearm. Intramedullary fixation with titanium elastic nails for paediatric diaphyseal forearm fractures is becoming the trending surgical technique in those cases that warrant surgical intervention. The purpose of this study was to evaluate the functional outcome of the management of fracture of both bones forearm in the older children with titanium elastic nailing system. METHODS This was a prospective study done among thirty patients aged 5 to 16 years admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu, Srikakulam with diaphyseal fractures of both bones forearm from September 2017 to September 2019. We treated the patients by closed / open reduction and internal fixation with elastic stable intramedullary nailing. The patients were followed-up for six months. RESULTS We evaluated the patients clinically and radiologically after surgery. We assessed the outcome using modified Anderson’s AO criteria for forearm fractures extracted from the international journal of current pharmaceutical and clinical research functions. All fractures united at an average of 9.1 weeks without any delayed or non-union. The results were excellent in 86.6 % of patients and good in 13.3 % of patients without significant complications. There were minor complications in 6 patients (20 %). CONCLUSIONS Titanium elastic intramedullary nailing is a safe, effective and minimally invasive surgical method for treatment of displaced both bones forearm diaphyseal fractures in older children. This technique gives relative stability with a three-point fixation principle resulting in secondary bone healing by promoting early callus, ideal for early mobilisation. The technique offers several advantages, including minimal incision, preservation of fracture haematoma, dynamic axial stabilisation, and shorter hospitalisation. KEYWORDS Both Bone Fracture Forearm, Titanium Elastic Nailing System, Early Mobilisation

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Functional outcome of elastic intramedullary nailing of forearm fractures in children using pin leverage technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192680 ◽

2019 ◽

Vol 5 (4) ◽

pp. 661

Author(s):

Alamgir Jhan ◽

Wazir Fahad Jan ◽

Ganesh Singh Dharamshaktu ◽

Tajinder Bhalla ◽

Saika Rasool ◽

...

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Closed Reduction ◽

Tertiary Care ◽

Plaster Cast ◽

Forearm Fractures ◽

Tertiary Care Centre ◽

Fractures In Children ◽

Diaphyseal Fractures ◽

Elastic Intramedullary Nailing

Background: There is a recent trend towards elastic intramedullary nailing in fixation of pediatric forearm bone diaphyseal fractures. But in children we should always attempt closed reduction and immobilsation in a moulded plaster cast. Irreducible, open fractures and those that get redisplaced in moulded plaster cast need operative fixation with intramedullary nailing. Our aim was to know the outcome of tens nailing in such fractures.Methods: We studied functional and radiological outcome of elastic intramedullary nailing by pin leverage technique in forearm fractures in 34 children. The study was done at a tertiary care centre in Uttrakhand, India from May, 2016 to July, 2018. Inclusion criteria were closed forearm fractures; diaphyseal fractures; age 1 to 19 years. Exclusion criteria were open type 2 and type 3 Gustillo-Anderson fractures; metaphyseal, epiphyseal forearm fractures; age >19 years; pathological fractures.Results: Closed reduction and percutaneous pin leverage technique for reduction was successful in all but 4 patients where limited open reduction was used for reduction of fracture fragments. All fractures united radiologically between 7 to 13 weeks with mean distribution of 9.2 weeks. For functional outcome we used modified Price and Daruwala’s score. 28 patients showed excellent results and 6 patients showed good results. All our patients had radiological union in mean of 9.2 weeks (7-13 weeks).Conclusions: Fixation with intramedullary TENS nailing is an effective and affordable way of treating patients in paediatric age group.

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Results of titanyum elastic intramedullary nailing (TEN) in forearm fractures in children; a retroseceptive analysis of 23 cases

Balıkesır Health Sciences Journal ◽

10.5505/bsbd.2012.44154 ◽

2012 ◽

Vol 1 (2) ◽

pp. 43-48

Author(s):

Gokhan Meric ◽

Bulent Kisin ◽

Mehmet Gem ◽

Ihsan Senturk ◽

Ali Engin Ulusal

Keyword(s):

Intramedullary Nailing ◽

Forearm Fractures ◽

Fractures In Children ◽

Elastic Intramedullary Nailing

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Peer review report 1 on “Comparison of hybrid fixation versus dual intramedullary nailing fixation for forearm fractures in older children”

International Journal of Surgery ◽

10.1016/j.ijsu.2016.04.011 ◽

2016 ◽

Vol 25 ◽

pp. 214

Keyword(s):

Peer Review ◽

Intramedullary Nailing ◽

Forearm Fractures ◽

Older Children ◽

Hybrid Fixation

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DCP vs LCDCP in forearm fractures: a comparative study of functional outcomes

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191783 ◽

2019 ◽

Vol 5 (3) ◽

pp. 454

Author(s):

Aaron R. D’souza ◽

Vamsi M. Krishna ◽

Kaushik S. Eswaran ◽

Shailesh Kumar

Keyword(s):

Comparative Study ◽

Functional Outcomes ◽

Forearm Fractures ◽

Group A ◽

Prospective Comparative Study ◽

Diaphyseal Fractures ◽

Both Bones ◽

Group B ◽

Limb Fractures ◽

Upper Limb Fractures

Background: Forearm fractures in general, and diaphyseal fractures in specific, are one of the most common fractures which accounts for about 31% of upper limb fractures seen in emergency. Early reduction and fixation is necessary in order to restore the function of forearm so as to be able to carry out their daily activities. The objective of this study was to compare the functional outcomes of forearm fractures fixed with DCP and LC DCP.Methods: The present study was a hospital based study, and a prospective, comparative study. A total of 40 patients with fracture of both bones forearm were taken up for the study, and randomly divided into 2 groups of 20 patients each. They were followed up for a period of 1 year.Results: The majority of patients were males (31 males and 9 females), involving age group 21-30. The left side was more common than right in both groups. The site of fracture was middle one-third of forearm in both groups (60% in group A and 65% in group B). The time for union was on average 4 weeks for LC DCP and DCP. ROM was full in 85% in DCP group and 90% in LC DCP group. Overall results were comparable in both groups. Excellent in 34 cases (18 in LC DCP, 16 in DCP), satisfactory in 5 cases (2 in LC DCP, 3 in DCP) and unsatisfactory in one case treated with DCP.Conclusions: LC DCP provides slightly better functional outcome in terms of time taken for union, early mobilisation and range of motion. However, it is more expensive than DCP.

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