Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

2020 ◽  
Vol 2 (2) ◽  
pp. 61-66
Author(s):  
Rajram Maharjan ◽  
Rishi Bisht ◽  
Dipesh Pariyar
Keyword(s):  
Femoral Shaft Fracture ◽  
Insertion Site ◽  
Operating Time ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Age Group ◽  
Femoral Shaft Fractures ◽  
Titanium Elastic Nailing ◽  
Shaft Fractures ◽  
Fractures In Children

Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN. Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria. Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails. Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.  

Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

2021 ◽  
Vol 15 (5) ◽  
pp. 1338-1340
Author(s):  
M. S. Zardad ◽  
M. Younas ◽  
S. A. Shah ◽  
I. Muhammad ◽  
M. Ullah ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Functional Outcomes ◽  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Femoral Shaft Fractures ◽  
Non Union ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

scholarly journals Observational study on titanium elastic nailing in femoral shaft fractures in children

2018 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Jyotirtmayee Bahinipati ◽  
R. G. Asutosh Mohapatra
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Limb Length Discrepancy ◽  
Shaft Fracture ◽  
Titanium Elastic Nailing ◽  
Fractures In Children ◽  
Group 5 ◽  
One Year ◽  
Prolonged Immobilization

<p class="abstract"><strong>Background:</strong> Nowadays femoral fractures in children are more commonly managed with operative fixation rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Our aim of study was to assess the outcome of titanium elastic nailing in femoral shaft fracture in children.</p><p class="abstract"><strong>Methods:</strong> Twenty five children in age group 5-15 years with femoral shaft fracture were stabilized with two titanium nails. Children were followed up for one year. The operative outcome was evaluated using criteria of Flynn. Complications associated with procedure were recorded and analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The final outcome was excellent in 67% (19 of 25) of patients, satisfactory in 16% (4 of 25) of patients and poor in 8% (2 of 25) of patients. Poor outcome was due to limb length discrepancy, pain in the knee and angular misalignment.</p><p class="abstract"><strong>Conclusions:</strong> We concluded that titanium elastic nailing is an ideal method of femoral shaft fixation in children.</p>

scholarly journals Role of Open Cerclage Wires Used in Patients with Comminuted Fractures of Femoral Shaft Treated with Intramedullary Nails

2020 ◽  
Author(s):  
Tzu-Hao Wang ◽  
Hao-Chun Chuang ◽  
Fa-Chuan Kuan ◽  
Chih-Kai Hong ◽  
Ming-Long Yeh ◽  
...  
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Fracture Treatment ◽  
Union Rate ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Cerclage Wiring

Abstract IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

scholarly journals Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alessandro Aprato ◽  
Davide Carlo Secco ◽  
Andrea D’Amelio ◽  
Elena Grosso ◽  
Alessandro Massè
Keyword(s):  
Pudendal Nerve ◽  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Harris Hip Score ◽  
Control Group ◽  
Complication Rates ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Abstract Background Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications. Methods We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications. Results Median age was 53 years, and median weight was 70 kg (range 50–103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% “excellent” reduction for subtrochanteric fractures, while 81 versus 79% “excellent” reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique. Conclusions Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail. Level of evidence: IV

scholarly journals Comparative study of day 01 spica cast versus skin traction followed by spica cast for treatment of closed femoral shaft fracture in children

2020 ◽  
Vol 2 (Number 1) ◽  
pp. 16-19
Author(s):  
Ripon Kumar Das
Keyword(s):  
Femoral Shaft ◽  
Shaft Fracture ◽  
Spica Cast ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
Skin Traction

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.

scholarly journals Management of compound fractures of shaft femur: a study of 55 cases

2016 ◽  
Vol 2 (4) ◽  
pp. 313
Author(s):  
Gaurav Singla ◽  
Amita Aggarwal ◽  
Ravinder Singh
Keyword(s):  
Femoral Shaft Fracture ◽  
Weight Bearing ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Deep Infection ◽  
Full Weight Bearing ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Mean Time

<p class="abstract"><strong>Background:</strong> Compound femoral shaft fractures are a major cause of morbidity and mortality. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilization and chances of wound infection are much higher. The objective of this study was to find out the outcome of treatment of open femoral shaft fractures by various modalities like interlocked nailing, plating and external fixation<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Fifty five patients with open femoral shaft fractures were treated under spinal or general anaesthesia. These fractures were in proximal one third (n=3), middle third (n=29), distal third (n=21). Fifty patients underwent surgery within 5 days of injury. Patients were followed for a minimum of 12 Months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients achieved union in an average time of 20 weeks (range 17 to 24 weeks). Full weight bearing was started in a mean time of 16 weeks. Mean duration of hospital stay was 20 days. Complications were occurred in ten patients (4 non-unions and 3 patients with deep infection and 3 patients developed chronic osteomyelitis)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results were excellent in 31, good in 13, fair in 3 and poor in 7 patients while one patient lost follow up as he was from far off place. We concluded that open femoral shaft fracture can be well managed by surgical intervention<span lang="EN-IN">.</span></p>

scholarly journals Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

2019 ◽  
Vol 26 (11) ◽  
pp. 1873-1877
Author(s):  
Muhammad Sajid Mehmood ◽  
Sultan Shah ◽  
Sajid Razzaq
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Femoral Shaft Fractures ◽  
Spica Casting ◽  
Shaft Fractures

Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

scholarly journals Treatment of Adult Femoral Shaft Fractures Using the Perkins Traction at Addis Ababa Tikur Anbessa University Hospital: The Ethiopian Experience

2012 ◽  
Vol 97 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Bahiru Bezabeh ◽  
Biruk L Wamisho ◽  
Maxime JM Coles
Keyword(s):  
Range Of Motion ◽  
Femoral Shaft Fracture ◽  
Motor Vehicle ◽  
Addis Ababa ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
University Hospital ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Tertiary Teaching

Abstract This is a prospective study to evaluate the efficacy of the Perkins traction in the treatment of adult femoral shaft fractures from October 1, 2007, to the present at the Black Lion Hospital in Addis Ababa University Hospital in Ethiopia. All femur fractures admitted to the hospital were reviewed and evaluated for treatment. Black Lion Hospital (Tikur Anbessa) is the university hospital in Addis Ababa and the highest tertiary teaching hospital in a country of 85 million inhabitants. A 67-bed orthopedic department offers the main ground for teaching to the undergraduate medical students. The hospital is also the pivotal center for the formation of the orthopedic residents. Patients from different parts of the country are referred to this institution for orthopedic care. A total of 68 adult (older than 16 years) patients with 69 femoral shaft fractures were considered for treatment during the study period. Consent was obtained and prospective treatment initiated. A standard Perkins traction was applied by an orthopedic team composed of consultants, orthopedic residents, physical therapists, and nurses. A protocol was developed for patients undergoing such traction. The physiotherapists will supervise all individual or group therapy sessions. Progressive knee range of motion to facilitate quadriceps and hamstring muscle strengthening exercises were implemented four times a day and recorded. Demographic information, fracture patterns, duration of traction, thigh circumference leg length discrepancy, and pin sites were routinely monitored and charted. Data were computerized and analyzed weekly, and appropriate adjustments were made accordingly. Clinical evidence of a competent callus and confirmation by radiographic studies will influence the cessation of traction to allow gait training with toe-touch crutch ambulation. Progress will be monitored during the following outpatient visits in the fracture clinic. A total of 68 consecutive patients with 69 femoral shaft fractures were treated with the Perkins traction. There were 60 men (88.2%) and only 8 women (11.8%), for a ratio of 8 men to 1 woman. The age of the cohort patient varied between 18 and 28 years. The mechanisms of injury for most of the fractures were motor vehicle accidents, resulting in an isolated femoral shaft fracture in 49.2% of the patients. Half of the fractures were by means of closed injury (n  =  44; 64.7%). One patient with a bilateral femoral shaft fracture was also added to the study. The right side was more often involved, with 41 fractures (60%), than the left, with 28 fractures (40%). Most of the fractures involved the proximal third of the femur (n  =  34; 50%), but the most common fracture pattern was transverse (n  =  29; 42.6%), followed by a comminuted pattern (n  =  18; 26.5%). Three segmental fractures were also encountered. The mean hospital stay was 45 days (33 patients; 48.5%), with the length of time in traction varying from 30 to 40 days. Only 2 patients remained in traction for a period of 60 days. At the end of the traction period, 8 patients (11.8%) showed a decrease in the quadriceps mass, and 7 patients (10.3%) showed stiffness of the knee with a range of motion limited to 0° to 90°. Most patients were discharged after about 8 months of treatment. One patient suffered a nonunion, and one was malunited. Superficial pin care infections were noted in 8 patients (11.8%) and treated appropriately. The conservative treatment of 69 femoral shaft fractures using the Perkins traction at Black Lion University Hospital in Addis Ababa, Ethiopia, has been proven to be a safe and effective method. It should be encouraged in countries like ours where it is a luxury to have a C-Arm in the operating room and where the hardware often is not available to perform a stable stabilization of the long bone fractures.

scholarly journals TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

2017 ◽  
Vol 5 (2) ◽  
pp. 13-21
Author(s):  
Mohit Khanna ◽  
Jitendra Wadhwani ◽  
Amit Batra ◽  
Sidharth Yadav ◽  
Sarfraz Iman ◽  
...  
Keyword(s):  
Prospective Study ◽  
Weight Bearing ◽  
Femoral Shaft ◽  
Full Weight Bearing ◽  
External Fixators ◽  
Age Group ◽  
Femoral Shaft Fractures ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Fractures In Children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

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