Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

Functional and radiological outcome after forearm plating in children and adolescent fracture

The literature on forearm overgrowth after plating in traumatic conditions is relatively poor though this technique can be useful when intra-medullary nailing is not sufficient in pediatric cases. The goal of this study was to assess a potential overgrowth after plating and identify impact on function. We conducted a retrospective study of all pediatric patients who underwent open surgery of the radius and/or ulna diaphysis with internal fixation by plating, in our institution, between October 2013 and July 2019. At last follow-up, functional and radiological outcomes were compared between the operated and uninjured forearm. Range of motion (ROM) of the wrist and elbow, clinical scores, radial and ulnar length were measured. A positive bone length discrepancy of more than 2mm was considered as an overgrowth. Were also studied the radio-ulnar index, radial inclination and radiocarpal angle. Thirteen patients were included. The mean age was 12.1 years old (±3.0 years), they were plated on the radius (10 cases) or on the ulna (3 cases). Mean follow- up was 4.4 years (± 1.8). In two cases, the plated bone (radius) was significantly longer than the uninjured one. There was no significant difference regarding radio-ulnar index, radial inclination and radiocarpal angle. The only statistically significant difference between the operated and uninjured forearm was the pronation/supination range, which was greater in the uninjured forearm (mean 160 ±48° versus 175 ±49°, p=0.01). This study confirms the good functional and radiological outcomes after plating even in a skeletally immature forearm. Level of evidence : IV.

Outcome of Elastic Stable Intramedullary Nailing (ESIN) for tibia fractures in children.

Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical & Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material & Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II & III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

<p>Two cases of medial migration of the hip screw in cases of cephalon-medullary nailing for the treatment of extra-articular proximal femoral fractures are reported. The first case was revised to hemiarthroplasty, that was subsequently complicated with infection and death of the patient, while the second was revised to a similar devise with favorable outcome. A review of the literature is performed in order to identify the contributing factors that result in the medial migration of the hip screw. Emphasis is given in further reporting of similar cases in order to abolish this potentially lethal complication. </p>