Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg.Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy.Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.

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MIPO For Complex Comminuted Bone Fractures in the Floating Knee IIC According Fraser: a Case Report

10.21203/rs.3.rs-841367/v1 ◽

2021 ◽

Author(s):

Chuangang Peng ◽

Guangkai Ren ◽

Minghan Dou ◽

Baoming Yuan ◽

Dankai Wu

Keyword(s):

Minimally Invasive ◽

Lower Limb ◽

Bone Structure ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Full Weight Bearing ◽

Minimally Invasive Plate Osteosynthesis ◽

Intraarticular Fracture ◽

Limited Mobility

Abstract Objective:Floating knee type IIC according to Fraser’s classification is an uncommon severe injury that typically occurs in polytrauma. In this case, mainly due to both intraarticular fracture and the high degree of comminution and malformation on the femoral mid-distal segments, fixation was challenging. The purpose of this study was to prove that minimally invasive plate osteosynthesis (MIPO) technology can simplify complex problems and improve prognosis. Case Presentation:A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly on the anterior aspect of the mid-distal thigh. Physical examination and lower limb computed tomography angiography (CTA) confirmed that the neurovascular status was normal. The clinical diagnosis were closed intraarticular fracture of the proximal tibia, open intraarticular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee.In this case, a locking plate system characterized by minimally invasive plate osteosynthesis (MIPO) technology was used as the treatment. Results and Conclusion:Postoperative evolution was satisfactory, with immediate functional exercise, full weight bearing after three months, and return to daily activity without pain. Final follow-up taken at 3 years showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

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Titanium Elastic Nails for Distal Radius-ulna Fractures in Young Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4509 ◽

2021 ◽

Author(s):

Harmanpreet Singh Sodhi ◽

Ashwani Kumar ◽

Arun Anand ◽

Vandana Sangwan ◽

Dhiraj Kumar Gupta

Keyword(s):

Distal Radius ◽

Bone Fractures ◽

Weight Bearing ◽

Medullary Canal ◽

Long Term Results ◽

Long Bone ◽

Uneventful Recovery ◽

Fractures In Children ◽

Ulna Fractures ◽

Elastic Nails

Background: Radius-ulna is the most frequently fractured bone of the pectoral limb in dogs with high predisposition to distal fractures. The smaller size of the distal fragment and open physis restrict the use of rigid fracture fixation techniques in distal fractures of growing dogs. Titanium elastic nails (TENs) are recommended in medical practice to stabilize long bone fractures in children. There is paucity of literature on TENs for the repair of radius-ulna fractures in dogs. Methods: This clinical study enrolled 10 dogs (7 grey hound and one each of Crossbred, Pomerenarian and Siberian Husky) suffering from distal radius-ulna (6 transverse and 4 short oblique) fractures since a mean ± SD duration of 3.40±4.5 days. The mean ± SD age and body weight of the dogs was 12.60±6.45 months and 14.09±6.41 Kg, respectively. All except one fracture was stabilized with two TENs inserted into the medullary canal of radial bone in a normograde manner from distal to proximal end using open cranio-lateral surgical approach. Result: Majority fractures achieved satisfactory reduction (n=8), radiographically. Weight bearing scores on walking increased gradually from day 12 (1.62 ± 1.51) to 45th (2.57±1.51), day 60th (3.75±0.5) and day 90 (4.0±0). Five dogs had uneventful recovery whereas remaining had major (n=2) or minor (n=3) complications. The length of the operated bone was non-significantly lesser as compared to contralateral healthy bone on day 60. Goniometric assessment of carpal joint of operated limb showed restricted range of motion on day 12 that improved to the near normal as contralateral healthy limb on day 60. Long-term results showed full (9) and acceptable (1) functional outcome. In conclusions, the TENs technique is simple and less invasive alternative fixation technique for distal radius-ulna fractures in young and light weighing dogs. As per authors, this is the first report on the use of TENs for the management of radius-ulna fracture in dogs.

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Screw osteosynthesis of transverse fracture of the patella in children

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000014 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000014

Author(s):

Simon Oksbjerre Mortensen ◽

Anne Mette Stausholm ◽

Rikke Thorninger

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Full Range ◽

Surgical Techniques ◽

Full Weight Bearing ◽

Transverse Fracture ◽

Excellent Outcome ◽

Fractures In Children ◽

Patella Fractures ◽

Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

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Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001509010073 ◽

2015 ◽

Vol 9 (1) ◽

pp. 73-77 ◽

Cited By ~ 4

Author(s):

Izzet Bingol ◽

Nadir Yalcin ◽

Vedat Bicici ◽

Tolga Tulunay ◽

Kaan Yuksel ◽

...

Keyword(s):

Minimally Invasive ◽

Soft Tissues ◽

Callus Formation ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Cohort Analysis ◽

Tibial Fractures ◽

Full Weight Bearing ◽

Complication Rates ◽

Distal Tibial Fractures

Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

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Functional outcome of proximal tibial fracture treated surgically using locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181471 ◽

2018 ◽

Vol 4 (3) ◽

pp. 400

Author(s):

Mahendra K. Aseri ◽

Vijaypal Singh ◽

Pradeep Kr. Sharma

Keyword(s):

Tibial Fracture ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Locking Compression Plate ◽

Full Weight Bearing ◽

Rigid Fixation ◽

Proximal Tibial Fracture ◽

Articular Fractures ◽

Compression Plate ◽

Post Traumatic

Background: Tibial plateau fractures are common intra-articular fractures, representing 1.2% of all fractures. These fractures are common in two age groups: as higher-energy fractures in younger patients and lower-energy fractures in elderly patients secondary to osteopenia. In the younger population, these injuries are associated with an increased incidence of complications like nonunion, infection, restriction of motion, and post-traumatic arthritis. The study aimed for final outcome of proximal tibial fracture using locking compression plate by minimally invasive percutaneous plate osteosynthesis (MIPPO).Methods: 30 cases of proximal tibial fractures were treated by using locking compression plate and studied from December 2015 to November 2017 in Department of Orthopaedics, Dr. S.N. Medical College associated group of Hospitals, Jodhpur.Results: All the selected 30 cases were followed up for 6 months. The average time for union of fracture was 21 weeks ranging from 18-24 weeks. Full weight bearing was not allowed until 12 weeks or complete fracture union. Partial immobilization was kept for 6 weeks in long knee brace. An average flexion was achieved upto0-1140. We observed 4 cases of postoperative complications that included 2 infections, one knee stiffness and one varus deformity.Conclusions: Surgical management of proximal tibia fractures with only lateral plating by MIPPO gave excellent reduction, rigid fixation to restore articular congruity and provides early motion to achieve optimal knee function and reducing post-traumatic osteoarthritis.

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Treatment of subtrochanteric fracture femur by open reduction and internal fixation by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195811 ◽

2019 ◽

Vol 6 (1) ◽

pp. 164

Author(s):

Prabhu P. Munavalli ◽

Gururaj N. G.

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Road Traffic ◽

Weight Bearing ◽

Subtrochanteric Fracture ◽

High Rate ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

Fractures In Children ◽

Pathologic Fractures

Background: Subtrochanteric fractures are devasting injuries that most commonly affect the elderly population and also in young.Methods: This is a prospective study of 20 cases of subtrochanteric fracture admitted to KIMS, Huballi between November 2008 to August 2010 treated with left proximal femoral nail (LPFN) by open method. Cases were taken according to inclusion and exclusion criteria, i.e., fresh subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Objectives of this study were to study subtrochanteric fractures and to determine effectiveness of LPFN in tretment of subtrochanteric fractures by open reduction and internal fixation (ORIF).Results: In our study of 20 cases, there were 16 male and 4 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 65% of the cases admitted were road traffic accidents, 25% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Good to excellent results were seen in 85% of cases in our study.Conclusions: Subtrochanteric fractures of femur can be successfully treated by ORIF by LPFN resulting in proper anatomical reduction and hence alignment and high rate of bone union.

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A Comparative Study Of Surgical Management Of Subtrochanteric Fractures In Children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i3.11718 ◽

2012 ◽

Vol 11 (3) ◽

pp. 178-184

Author(s):

RL Sahu ◽

P Gupta

Keyword(s):

Femoral Fracture ◽

Weight Bearing ◽

Excellent Result ◽

Medical Science ◽

Long Bone ◽

Full Weight Bearing ◽

Entry Site ◽

Early Weight Bearing ◽

Fractures In Children ◽

Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11718 Bangladesh Journal of Medical Science Vol. 11 No. 03 July12

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A comparative study of surgical management of subtrochanteric fractures in children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i2.9664 ◽

2012 ◽

Vol 11 (2) ◽

pp. 91-97

Author(s):

Ramji Lal Sahu ◽

Pratiksha Gupta

Keyword(s):

Femoral Fracture ◽

Weight Bearing ◽

Medical Science ◽

Femoral Fractures ◽

Long Bone ◽

Full Weight Bearing ◽

Entry Site ◽

Early Weight Bearing ◽

Fractures In Children ◽

Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result.DOI: http://dx.doi.org/10.3329/bjms.v11i2.9664 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 91-97

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Structural Health Monitoring of Long Bone Fractures Using Instrumented Intramedullary Nails

Smart Materials, Adaptive Structures and Intelligent Systems, Volume 2 ◽

10.1115/smasis2008-314 ◽

2008 ◽

Cited By ~ 1

Author(s):

Darren Wilson ◽

Si Janna

Keyword(s):

Fracture Healing ◽

Stance Phase ◽

Bone Fractures ◽

Weight Bearing ◽

Long Bone ◽

Full Weight Bearing ◽

Radiographic Evidence ◽

Linear Load ◽

Single Sensor ◽

Primary Bone

Clinical assessment of fracture healing is usually subjective, relying upon the detection of movement (‘feel’) by the surgeon, the patient’s response in terms of pain and confidence, and radiographic evidence of callus and primary bone union. A more quantitative, objective method of measuring the strength of a healing callus would be useful in assessing many aspects, such as the effectiveness of different forms of treatment, the pattern and rate of healing, and the stage at which the patient can return to full weight-bearing activity. The results presented in this paper demonstrate the complexity of monitoring fracture healing in leg stance phase using an instrumented intramedullary (IM) nail equipped with a single sensor. The bone healers exhibited both sigmoidal and linear load responses during fracture healing. Ambulating non-healers demonstrated high nail forces which did not change significantly over time whereas lame non-healers demonstrated a decreasing nail load due to reduced GRF or loosening of fixation.

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Radiation-free interlocking intramedullary nailing of three-hundred and seventy long bone fractures in Ogbomoso, Nigeria

Scientific Reports ◽

10.1038/s41598-021-89544-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Stephen Adesope Adesina ◽

Samuel Uwale Eyesan ◽

Innocent Chiedu Ikem ◽

Olalekan Akeem Anipole ◽

Isaac Olusayo Amole ◽

...

Keyword(s):

Developing Countries ◽

Bone Fractures ◽

Weight Bearing ◽

Age Groups ◽

Previous Treatment ◽

Long Bone ◽

Full Weight Bearing ◽

Post Discharge ◽

Long Bone Fractures ◽

Wide Range

AbstractLong bone fracture care in developing countries remains largely different from that of the developed world where closed reduction and internal fixation with locked intramedullary nail is the standard treatment. This study in a developing country presents the pattern and outcome of treatment of 370 long bone fractures using the SIGN nail over a five-year period in order to underline the wide array of patients and fractures treatable with the nail. Using a prospective descriptive approach, all the 342 patients with 370 fractures of the humerus, femur and tibia treated from July 2014 to June 2019 were studied. The fractures were reduced without image intensifier or fracture table and fixed with the SIGN nail. Post-discharge, the patients were followed up at the out-patient clinic. The mean age of the patients was 43.45 years with a range of 10–99 years. Sixty-six percent were males who were mostly injured in motorcycle accidents. Femur, tibia and humerus fractures accounted for 59.7%, 28.4% and 11.9% respectively. Eighty-six percent were diaphyseal fractures, 73% were fresh and the main previous treatment was traditional bone setting. Deep infection occurred in 4.9%, 66.0% achieved knee flexion > 90° by sixth week, the majority achieved full weight bearing and could squat and smile by 12th week. The SIGN nail is versatile, useful for treating a wide range of fractures in most age groups particularly in developing countries where orthopaedic fractures are prevalent but the more sophisticated facilities are lacking or poorly maintained.

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