Tibial Diaphysis Fracture in Paediatric Age Group: Outcome with Elastic Nailing Fixation in Tertiary Care Center in Lumbini Province of Nepal

Introduction- Tibial diaphysis fracture in paediatric age group accounts for 10 to 15% of all fractures. Fixation of tibial diaphysis fracture in paediatric age group by elastic nailing system provides relative stability. The purpose of this study is to evaluate the functional outcome of tibial diaphysis fracture in paediatric age group treated elastic nailing system. Methods- A prospective interventional study was conducted at Rapti Academy of Health Sciences, Ghorahi, Dang from November 2018 to November 2020. Ethical clearance was obtained from Institutional review board. All the children who were operated for tibial diaphysis fracture were followed up for six months. Final outcome was analyzed at final follow up. Results- Out of thirty children, there were sixteen male and fourteen female. Mean time of fracture union was 10.03 weeks. Two children develop limb lengthening of 1.5 cm and 1.2 cm respectively. One child had 1 cm shortening and three children develop bursitis on entry site. At final follow up 83.33% of child had an excellent outcome according to Flynn grading. Conclusion- Tibial diaphysis fracture can be treated with elastic nailing system with excellent to good functional outcomes.

Effect of Age on Bone Structure Parameters in Laying Hens

Changes in medullary and cortical bone structure with age remain unclear. Twenty Hy-Line W36 hens, 25 or 52 weeks of age, were euthanized, and both tibiae were collected when an egg was present in the magnum. Serial cross sections of the tibiae were stained with Alcian blue. The bones were scanned using micro-computed tomography. Trabecular width (Tb.Wi) was significantly higher (p < 0.05) in 25-week-old hens, whereas medullary bone tissue volume (TV) was significantly higher (p < 0.01) in 52-week-old hens. 25-week-old hens had significantly higher (p < 0.01) bone volume fraction (BVF = calcified tissue / TV). Moreover, the cortical bone parameters were significantly higher (TV and bone mineral content (BMC) at p < 0.05, and bone volume (BV) and BVF at p < 0.01) in younger hens. Open porosity and total porosity, which indicate less density, were significantly higher (p < 0.01) in older hens. Older hens showed significantly higher (p < 0.01) tibial diaphysis TV than younger hens. Younger hens had significantly higher (p < 0.01) BV, BVF and bone mineral density (BMD) of the tibial diaphysis. These findings reveal that reductions in medullary bone quality might be associated with age-related low estrogen levels and stimulation of osteoclastic bone resorption by parathyroid hormone. Cortical bone quality decreased with enlargement of the Haversian canals and loss of volume, with a longer egg-laying period leading to osteoporosis.