Pediatric long bone fractures treated by elastic intramedullary nailing

<p class="abstract"><strong>Background:</strong> Pediatric long bone fractures can have a high morbidity and long term disability among the survivors. The present study was aimed to study the clinical outcomes of children with long bone fractures managed by elastic intramedullary nail.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed the medical records of children (aged 2 to 15 years) who were admitted and treated for unilateral femoral, tibial or forearm fractures with elastic intramedullary nail from January 2018 till February 2020. All were managed with elastic intramedullary nailing. The union times and complications were noted from the medical records.<strong></strong></p><p class="abstract"><strong>Results:</strong> Femoral, tibial and forearm bones were involved in 15 patients each (33.3%). Road traffic accident was reported by 31%) and physical abuse by one case (2%). The mean time of union was 10 weeks, ranging from 6 to 12 weeks. The mean time for union of the femur and tibia was 11.54 and 11.34 weeks respectively. It was significantly lower for forearm (6.67 weeks, p value &lt;0.05). Two patients reported of bursitis and impingement, which were resolved after nail removal. One case had limb length discrepancy of about 0.5 cm in femur fracture, which was not impairing functional activity. Functional status was assessed based on Flynn criteria was found to be excellent in 36%, good in 44% and fair in 20%.</p><p class="abstract"><strong>Conclusions:</strong> The results of the present study show that titanium elastic nail (TEN) is an effective treatment modality for managing pediatric long bone fractures. We recommend the use of TEN in managing long bone fractures in children.</p>

Retrospective medico-social analisys of the results of treatment patients with the concequences of long bone fractures

The problem of long bones fractures treatment remains actual, despite a significant number of studies carried out on this topic. Such fractures of the musculoskeletal system occur more often and are accompanied by various complications, significantly compromise the quality of patients life and often lead to the disability. Objective. To analyze different types of traumatic injuries in patients with the consequences of long bone fractures, to evaluate the effectiveness of diagnostics, treatment and to analyze the state of disability. Methods. A retrospective medical and social analysis of the results of treatment of 333 patients (232 (69.6 %) men, 101 (30.4 %) women) with the consequences of long bone fractures, based on the obtained study group in the Kharkiv Regional Center for Medical and Social Expertise № 2, for the period 2018–2019. Results. Three main methods of surgical treatment were analyzed: internal fixation (ORIF), blocking intramedullary nailing (IMN) and treatment with external fixation devices (EF). They were applied in the following rate: ORIF — 204 (61.3 %) cases, IMN — 98 (29.4 %), EF — 31 (9.3 %). The most typical complications of the treatment of patients with fractures of the long bones were delayed union or nonunion, neuropathies of the treated extrimities, joint contractures, osteoarthritis of adjacent joints, deformities of affected extrimities, osteomyelitis. Causes of disability were: 63 % — severity of injuries, 46 % — different posttraumatic complications, 6.5 % — iatrogenic complications. Among the latter, the most common were: diagnostic — 7.1 %, incorrect method of treatment — 29.7 %, iatrogenic incorrect surgery methods — 45 %. Conclusions. The data obtained showed that the improvement of organization measures for the prevention of complications and disability in patients with consequences of long bones fractures could help to increase the efficiency and quality of specialized medical help. Key words. Fractures, long bones, limbs, consequences, complications, disability.

Study of relation of type of fracture with amount of postoperative fluid therapy and duration of hospital stay after surgery

Background: Post-earthquake in Nepal many patients were rescued by the Nepalese Army and transferred to Shree Birendra Hospital where they were managed and discharged postoperatively to the area with substandard care. Objectives: This study aimed to establish the relation of type of fracture with the amount of fluid infused/transfused and postoperative hospital stay during earthquake victim resuscitation and care in April 2015. Methods: Hospital based data registered during the period of 25th April 2015 to 15th May 2015 were collected for this analytical study design. Seventy-five orthopaedic cases were selected randomly and analysed with software Minitab 17. Results: Fifty-three patients had long bone fractures, out of which 32 were infused with low, 18 with moderate, and three with high amounts of fluids. Similarly, 15 patients with non-long bone fractures were infused with low and seven patients with moderate amounts of fluid. The Chi-square association between type of fracture and amount of postoperative fluid therapy is 1.418, DF = 2 with p = 0.49. Similarly, the Chi-square association between the type of fracture and duration of hospital stay is 5.423 with DF = 4 and p = 0.247. Conclusion: Long bone fractures are more debilitating but are not a cause for long hospital stay postoperatively. And there is no significant relationship between the type of fracture and the amount of postoperative fluid therapy. Hence during the time of disaster, patients can be cared for in the hospital ward for a certain time and shifted to other areas of sub-standard care. This in turn can accommodate large victims during such critical times.

Does Surgical Technique Influence the Burden of Lung Metastases in Patients with Pathologic Long Bone Fractures?

Background: The aims of this study are to (1) determine whether fixation of metastatic long bone fractures with an intramedullary nail (IMN) influences the incidence of lung metastasis in comparison to arthroplasty or ORIF (Arthro/ORIF); and (2) assess this relationship in primary tumor types; and (3) to assess survival implications of lung metastasis after surgery.Methods: Retrospective cohort study investigating 184 patients (107 IMN, and 77 Arthro/ORIF) surgically treated for metastatic long bone fractures. Patients were required to have a single surgically treated impending or established pathologic fracture of a long bone, pre-operative lung imaging (lung radiograph or computed tomography) and post-operative lung imaging within 6 months of surgery. Primary cancer types included were breast (n=70), lung (n = 43), prostate (n = 34), renal cell (n = 37). Statistical analyses were conducted using two-tailed Fisher’s exact tests, and Kaplan-Meier survival analyses.Results: Patients treated with IMN and ORIF/arthroplasty developed new or progressive lung metastases following surgery at an incidence of 34% and 26% respectively. Surgical method did not significant influence lung metastasis (p = 0.33). Furthermore, an analysis of primary cancer subgroups did not yield any differences between IMN vs Arthro/ORIF. Median survival for the entire cohort was 11 months and 1-year overall survival was 42.7% (95% CI: 35.4-49.8). Regardless of fixation method, the presence of new or progressive lung metastatic disease at follow up imaging study was found to have a negative impact on patient survival (p <0.001).Conclusions: In this study, progression of metastatic lung disease was not affected by long bone stabilization strategy. IM manipulation of metastatic long bone fractures therefore may not result in a clinically relevant increase in metastatic lung burden. The results of this study also suggest that lung metastasis within 6 months of surgery for metastatic long bone lesions is negatively associated with patient survival. Level of Evidence: III, therapeutic study