Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

Comparison of three treatment methods for simple bone cyst in children

Background The unicameral bone cyst (UBC) is a kind of benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM), and the combination of ESIN and ABM in the treatment of bone cyst in children. Methods Eighty-three cases with simple bone cyst were analyzed retrospectively. Twenty-eight cases were treated with ABM. Twenty-eight cases were treated with ESIN. Twenty-seven cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT, or MRI scans. For the suspicious ones, the pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for postoperative evaluation of three methods. Results All cases accomplished the follow-up. The effective rate of the ABM + ESIN group was significantly higher than that of the ABM group (P < 0.05), and the cure rates of the ESIN group and the ABM + ESIN group were higher than that of the ABM group (P < 0.05, respectively). The cure time in the ESIN group was lower than that of the other two groups (P < 0.05, respectively). The times for admission were 2.0 ± 0.0 in the ESIN group, 5.7 ± 1.9 in the ABM group, and 4.7 ± 2.4 in the ABM + ESIN group (P < 0.05 when compared with each other). Conclusions The method of ABM combined with ESIN for children’s bone cyst has the highest effective rate and curative rate. For the individual method, ESIN has a higher effective rate and curative rate than that of ABM. Meanwhile, it has the fewest time of hospitalization.

Comparison of three treatment methods for simple bone cyst in children

Background The unicameral bone cyst (UBC) is a kind of benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM), and the combination of ESIN and ABM in the treatment of bone cyst in children. Methods 83 cases with simple bone cyst were analyzed retrospectively. 28 cases were treated with ABM. 28 cases were treated with ESIN. 27 cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT, or MRI scans. For the suspicious ones, the pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for postoperative evaluation of three methods. Results All cases accomplished the follow-up. The effective rate of the ABM+ESIN group was significantly higher than that of the ABM group (P<0.05), and the cure rates of the ESIN group and the ABM+ESIN group were higher than that of the ABM group (P<0.05, respectively). The cure time in the ESIN group was lower than that of the other two groups (P<0.05, respectively). The times for admission were 2.0±0.0 in the ESIN group, 5.7±1.9 in the ABM group, and 4.7±2.4 in the ABM+ESIN group (P<0.05 when compared with each other). Conclusions The method of ABM combined with ESIN for children’s bone cyst has the highest effective rate and curative rate. For the individual method, ESIN has a higher effective rate and curative rate than that of ABM. Meanwhile, it has the fewest time of hospitalization.

Comparison of three treatment methods for simple bone cyst in children

Background Unicameral bone cyst (UBC) is a benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM) and the combination of ESIN and ABM in the treatment of simple bone cyst of children. Methods 83 children with simple bone cyst were analyzed retrospectively. 28 cases were treated with ABM. 28 cases were treated with ESIN. 27 cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT or MRI scans. For the suspicious ones, pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for the postoperative evaluation of the three methods. Results All the cases accomplished the follow-up. The effective rate of ABM+ESIN group was significantly higher than that of the ABM group (P<0.05), and the cure rates of ESIN group and ABM+ESIN group were higher than that of ABM group (P<0.05, respectively). The cure time in ESIN group was lower than that of the other two groups (P<0.05, respectively). The times for admission were 2.0±0.0 in ESIN group, 5.7±1.9 in ABM group and 4.7±2.4 in ABM+ESIN group (P<0.05 when compared with each other). Conclusions The method of ABM combined with ESIN for children bone cyst has the highest effective and curative rates. For individual method, ESIN has a higher effective rate and curative rate than that of ABM. Meanwhile, it has the fewest hospitalizations.

Comparison of three treatment methods for simple bone cyst in children

Background Unicameral bone cyst (UBC) is a benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM) and the combination of ESIN and ABM in the treatment of simple bone cyst of children.Methods 83 children with simple bone cyst were analyzed retrospectively. 28 cases were treated with ABM. 28 cases were treated with ESIN. 27 cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT or MRI scans. For the suspicious ones, pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for the postoperative evaluation of the three methods.Results All the cases accomplished the follow-up. The effective rate of ABM+ESIN group was significantly higher than that of the ABM group (P<0.05), and the cure rates of ESIN group and ABM+ESIN group were higher than that of ABM group (P<0.05, respectively). The cure time in ESIN group was lower than that of the other two groups (P<0.05, respectively). The times for admission were 2.0±0.0 in ESIN group, 5.7±1.9 in ABM group and 4.7±2.4 in ABM+ESIN group (P<0.05 when compared with each other).Conclusions The method of ABM combined with ESIN for children bone cyst has the highest effective and curative rates. For individual method, ESIN has a higher effective rate and curative rate than that of ABM with the lowest time of admission.

Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails

Purpose: To describe patient characteristics and to compare outcomes of children undergoing rigid intramedullary nailing of tibial fractures as compared with those operated on using elastic intramedullary nailing. Methods: A retrospective review of 26 children who have undergone flexible intramedullary nailing of tibial fractures and 30 children with rigid nailing at our university hospital between 2008 and 2017. The patient charts and radiographs were evaluated to identify demographic characteristics and several variables were measured preoperatively, as well as 6–12 weeks postoperatively in addition to final follow-up radiographs. Results: Twenty-six patients (26/26, 100%) treated with a flexible nail and 14 patients (14/30, 46.7%) treated with a rigid nail had open proximal tibial physis (p < 0.001). An acceptable postoperative alignment was obtained in 20 patients (20/26, 76.9%) in the elastic stable intramedullary nail group and in 29 patients (29/30, 96.7%) in the rigid group (p = 0.026). Some complications occurred in four patients (4/26, 15%) in the elastic stable intramedullary nail population and seven patients (7/30, 23%) in the rigid intramedullary nail population (p = 0.46). Malunion occurred in six patients (6/26, 23%) in the elastic stable intramedullary nail group and in none of the patients treated with a rigid intramedullary nail (p = 0.005). Conclusion: Younger children with tibial fractures who weight 50 kg or less and with proximal tibial growth plates wide open can be treated with elastic stable intramedullary nail while more mature adolescents benefit from rigid intramedullary nailing.

Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital

Background: Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital.Methods: A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality.Results: 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0).Conclusion: This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fracturesKeywords: cast index, intermedullary nailing, elastic stable intramedullary nail, open reduction, internal fixationFunding: Personal funding