Comparing titanium elastic nailing and plate osteosynthesis in treating both bone diaphyseal fractures of forearm in children

<p class="abstract"><strong>Background:</strong> The present study aimed to compare the outcome of fixation of diaphyseal fractures of both bones of forearm using plate osteosynthesis (PO) and titanium elastic nail (TEN).</p><p class="abstract"><strong>Methods:</strong> This comparative non-randomized clinical trial was done on children aged 5 to 15 years, with diaphyseal fractures of both bone forearm fractures, operated and managed at the department of orthopedics, Assam Medical College and Hospital, Dibrugarh. Intra- and post-operative findings were compared between PO and TEN group patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Duration of hospital stay was significantly lower in patients in the TEN group (44.75±6.38 minutes) as compared to those in the PO group (69.71±5.91 minutes), p value &lt;0.01. Similarly, duration of hospital stay was significantly lower in patients in the TEN group (5.01±0.67 days) as compared to those in the PO group (8.32±1.44 days), p value &lt;0.05. Based on price criteria, 80% of the patients in the PO group and 85% in TEN group had excellent functional outcome. Radiological union time, maximum radial bow and location of maximal radial bow were found to be statistically similar in the two groups. Complication rate was similar in the two study groups.</p><p class="abstract"><strong>Conclusions:</strong> Based on the results of the present study, we conclude that both PO and TEN are be safely performed in children with diaphyseal both bone forearm fractures. With comparable functional and radiological outcomes, future studies are required before one technique can be recommended over the other.</p>

Management of complex femur fractures in children: A report of Three Cases

Introduction:Complex femur fractures are defined as combined fractures of shaft and proximal of or the distal femur. Restoration of anatomical alignment is the primary goal of the management of these fractures. In this report, we describe the management of complex femur shaft fractures in three pediatric patients. Case Report: This report includes three patients. The first patient was a 10-year-boy with comminuted proximal femur shaft fracture extending into the subtrochanteric area, managed with minimally invasive sub-muscular plating. The second patient was a 12-year-boy with comminuted femur shaft extending into subtrochanteric area, treated with combined retrograde and anterograde Titanium Elastic Nail System. A 12-year-old boy with femur shaft with intertrochanteric fracture managed with K-wire fixation for intertrochanteric fracture and plating with dynamic compression plate for femur shaft was our third patient. All patients had excellent radiological and functional outcome. Conclusion: Complex femur shaft fractures in children are very rare and challenging injuries. With proper pre-operative planning and use of appropriate implants excellent outcomes can be obtained. Keywords:Complex femur fractures, pediatric orthopedics, sub-muscular plating, titanium elastic nailing.

Minimally Invasive Treatment of Pelvic Fractures With Titanium Elastic Nailing: an Innovative Technology

Background: Minimally invasive treatment has become the most popular and effective method for the treatment of pelvic fractures. The aim of this study was to evaluate the safety and efficacy of a new technique, titanium elastic nailing (TEN), for the minimally invasive treatment of pelvic fractures. Methods: 18 patients with pelvic fractures were referred to us between March 2020 to November 2020, including 13 males and 5 females. The pelvic fractures were temporarily fixed by pelvic fixation belt accompanied with the traction from lower limb bone. The anterior pelvic ring injury (superior ramus of pubis) and ilium fracture were all treated with closed reduction and intramedullary fixation with minimally invasive TEN. Intraoperative C-arm, including pelvic anteroposterior, pelvic outlet, inlet and ilium oblique view) and O-arm fluoroscopy (intraoperative CT) were employed to determine the reduction of fractures and the location of elastic titanium nails in the bone channel. Results: By adopting closed reduction and minimally invasive incision, the pelvic fractures could be safely fixed by placing the elastic titanium nail in the osseous medullary cavity channels of the pelvis. Postoperative investigation indicated that the wounds of all the patients were healed in the first stage, without any occurrence of complications such as nerve, blood vessel and important tissue structure injuries. The patients recovered quickly after the operation and could perform functional exercise in the early stage. Conclusion: TEN can be used for the minimally invasive treatment of pelvic fractures. This novel technique has no obvious complications and worthwhile to use in clinic practice.

Wedge Osteotomy with Tens Nailing in Monostotic Fibrous Dysplasia of Tibia – A Case Report

Introduction: Titanium elastic nailing (TENS) with wedge osteotomy for the management of monostotic fibrous dysplasia (FD) of tibia is done in a 6-year-old male patient. Case Report: This is a case describing monostotic FD of right tibia in a 6-year-old male patient. The patient’s parents noticed a diffuse swelling in the right leg a few days after birth. It was managed conservatively till 3 years of age when the patient started complaining of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was diagnosed with monostotic FD of the right tibia based on clinical and radiological findings. Wedge osteotomies were done in the tibia and fibula with TENS nailing as a definitive procedure for this patient. Discussion: Management of monostotic FD of the right tibia with TENS nailing and wedge osteotomy can be a possible modality of definitive management with complete pain relief and deformity correction. Conclusion: Correction of deformities secondary to FD requires meticulous pre-operative planning and execution. But with proper planning, even major deformities as in our case, procedures as simple as wedge osteotomy and TENS nailing can give excellent outcomes. Keywords: Fibrous dysplasia, monostotic, titanium elastic nailing.

Prospective Study of Surgical Management of Diaphyseal Fractures of Both Bones Forearm in Older Children Using Titanium Elastic Intramedullary Nailing at a Tertiary Care Hospital in Srikakulam

BACKGROUND Diaphyseal fractures of the forearm are one of the common fractures in the paediatric population. Closed reduction and cast immobilisation remain the standard treatment for paediatric diaphyseal forearm fractures owing to their unique remodelling potential. The main concern of conservative management is re-displacement of fracture in cast resulting in the unacceptable angular deformity in the forearm. Intramedullary fixation with titanium elastic nails for paediatric diaphyseal forearm fractures is becoming the trending surgical technique in those cases that warrant surgical intervention. The purpose of this study was to evaluate the functional outcome of the management of fracture of both bones forearm in the older children with titanium elastic nailing system. METHODS This was a prospective study done among thirty patients aged 5 to 16 years admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu, Srikakulam with diaphyseal fractures of both bones forearm from September 2017 to September 2019. We treated the patients by closed / open reduction and internal fixation with elastic stable intramedullary nailing. The patients were followed-up for six months. RESULTS We evaluated the patients clinically and radiologically after surgery. We assessed the outcome using modified Anderson’s AO criteria for forearm fractures extracted from the international journal of current pharmaceutical and clinical research functions. All fractures united at an average of 9.1 weeks without any delayed or non-union. The results were excellent in 86.6 % of patients and good in 13.3 % of patients without significant complications. There were minor complications in 6 patients (20 %). CONCLUSIONS Titanium elastic intramedullary nailing is a safe, effective and minimally invasive surgical method for treatment of displaced both bones forearm diaphyseal fractures in older children. This technique gives relative stability with a three-point fixation principle resulting in secondary bone healing by promoting early callus, ideal for early mobilisation. The technique offers several advantages, including minimal incision, preservation of fracture haematoma, dynamic axial stabilisation, and shorter hospitalisation. KEYWORDS Both Bone Fracture Forearm, Titanium Elastic Nailing System, Early Mobilisation