EARLY OUTCOMES OF FLEXIBLE INTRAMEDULLARY NAILING IN PEDIATRIC SHAFT OF FEMUR FRACTURES

Objective: To study the early outcomes and complications of fixation of pediatric shaft of femur fractures using flexible intramedullary nail. Study Design: Prospective observational study. Place and Duration of Study: Orthopedic Department, Bahawal Victoria Hospital Bahawalpur, from Jan to Jun 2021. Methodology: Children between the ages of 5-11 years with shaft of femur fractures were included in the study. Fixation of fracture was done using elastic intramedullary nail. Final outcomes of fixation were observed using Flynn and Schwend Scoring System. Six-month follow-up was done in all cases. Data was analyzed using SPSS-20. Results: Total 70 cases having shaft of femur fracture were included in the study. Age range of cases was 5-11 years with mean age of 7.75 ± 1.66 years and mean weight of 24.44 ± 4.77 kilograms. Mean diameter of femur medullary canal was 7.48 ± 0.63 millimeters and mean diameter of flexible nail was 3.03 ± 0.26 millimeters. Mean post-operative period of radiological union of fracture was 8.57 ± 1.05 weeks. Per-operatively, fracture site was approached in 4 (5.7%) cases. Migration of nail was not seen in any case. Final outcomes according to Flynn and Shwend Score were excellent in 62 (88.5%), satisfactory in 7 (10%) and poor in 1 (1.4%) case. Conclusion: Fixation of shaft of femur fracture using flexible intramedullary nailing technique is safe and reliable with good outcomes among children between 5-11 years of age.

Comparison of Clinical Outcomes of Flexible Intramedullary Nailing (FIN) with External Fixation in Pediatric Open Tibial Fractures

Objective: To compare the clinical outcome of flexible intramedullary nailing (FIN) with external fixator in pediatric open tibial fractures. Subjects and Methods: In this randomized comparative study, 80 children having age 5 year to 14 years who presented with open tibial fractures were included. The study was conducted from June-2020 to June-2021 in Islam Hospital Sialkot and Allama Iqbal Memorial Hospital Sialkot. Patients were divided into two equal groups. Group A: underwent external fixation and group B: underwent flexible intramedullary nailing for the surgical management of tibial fractures. Frequency of infections surrounding pins, painful bursitis and re fracture rate within 3 months after surgery was recorded. Results: The mean age of children was 8.42±3.82 years in external fixator group versus 8.40±4.0 years in FIN group (p-value 0.97). Infection-surrounding pins occurred in 9 (22.5%) children were belonging to external fixator group and 01 (2.5%) children was belonging to FIN group (p-value 0.007). Refracture occurred in 6 (15.0%) patients in external fixator group and in no (0.0%) children in FIN group (p-value 0.01). Painful bursitis occurred 2 (5.0%) patient was in external fixator group and in 13 (32.5%) in FIN group (p-value 0.002). Conclusion: Clinical outcome is better in patients treated with FIN as compared to the external fixator for the treatment of pediatric open tibial shaft fractures. Keywords: Flexible intramedullary nails, External fixator, Tibial fractures.

Casting versus flexible intramedullary nailing in displaced forearm shaft fractures in children aged 7–12 years: a study protocol for a randomised controlled trial

IntroductionThe forearm is the most common fracture location in children, with an increasing incidence. Displaced forearm shaft fractures have traditionally been treated with closed reduction and cast immobilisation. Diaphyseal fractures in children have poor remodelling capacity. Malunion can cause permanent cosmetic and functional disability. Internal fixation with flexible intramedullary nails has gained increasing popularity, without evidence of a better outcome compared with closed reduction and cast immobilisation.Method and analysisThis is a multicentre, randomised superiority trial comparing closed reduction and cast immobilisation to flexible intramedullary nails in children aged 7–12 years with >10° of angulation and/or >10 mm of shortening in displaced both bone forearm shaft fractures (AO-paediatric classification: 22D/2.1–5.2). A total of 78 patients with minimum 2 years of expected growth left are randomised in 1:1 ratio to either treatment group. The study has a parallel non-randomised patient preference arm. Both treatments are performed under general anaesthesia. In the cast group a long arm cast is applied for 6 weeks. The flexible intramedullary nail group is immobilised in a collar and cuff sling for 4 weeks. Data are collected at baseline and at each follow-up until 1 year.Primary outcome is (1) PROMIS paediatric upper extremity and (2) forearm pronation-supination range of motion at 1-year follow-up. Secondary outcomes are Quick DASH, Paediatric Pain Questionnaire, Cosmetic Visual Analogue Scale, wrist and elbow range of motion as well as any complications and costs of treatment.We hypothesise that flexible intramedullary nailing results in a superior outcome.Ethics and disseminationWe have received ethical board approval (number: 78/1801/2020) and permissions to conduct the study from all five participating university hospitals. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications.Trial registration numberNCT04664517.

Elastic intramedullary nail treatment of adolescent perihardware radius and ulna refracture

A 13-year-old girl presented to the clinic with a midshaft refracture of both forearm bones adjacent to the site of a prior forearm fracture that had been treated with plating. She was treated with hardware removal and placement of elastic intramedullary nails. Flexible intramedullary nailing can be successful for a skeletally mature adolescent in treatment of refracture surrounding plate fixation of a midshaft forearm fracture. This technique allows for additional protection of the entire length of the affected bones, while avoiding the extensive dissection needed for extended plating.