A prospective study on the functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nailing: A case series of 22 cases

Abstract

Introduction: Shaft of femur fracture are one of the most common diaphyseal fractures in children with an incidence of about 19/1 lakh population. The aim of treatment is mainly anatomical reduction and realignment with proper functioning of hip and knee joints. TENS is now the preferred treatment of choice because it involves the insertion of two or three titanium nails. Aim of Study: The aim of this study was to assess functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nail. Materials and Methods: The study has been conducted in Department of Orthopaedic, K.R. Hospital December 2017 and December 2018. Patients underwent operative treatment on table with manual traction. After proper reduction of fracture, small skin incision was given on either side of distal thigh around 2 cm proximal to distal epiphyseal plate. Titanium elastic nail of the correct size with curve ends were introduced from both medial and lateral side simultaneously till fracture site after it one nail was passed across the already reduced fracture site followed by another one. Postoperatively patients were encouraged quadriceps strengthening and knee bending exercises as soon as patients could tolerate (Usually within 24 hours of surgery) and for few days, patients were kept non-weight bearing following which partial weight bearing allowed depending on the stability of fracture and callus formation but full weight bearing was allowed only after radiological evidence of firm union. Results: Total 22 patients with shaft femur fracture were operated between December 2017 and 2018 with TENS nail in the Department of Orthopaedics K.R Hospital. There were 15 boys and 7 girls aged between 5-15 years who were taken. Most of the cases were due to RTA (54%) and self-fall accounted for 46%. Out of the fractures, proximal accounted for 9%, mid-shaft fractures 68% and remaining were distal. The most common side affected in our case series was right which was in 17 kids (77%). Out of all types of fractures, transverse accounted for 31%, spiral 22% and the remaining were oblique. Closed reduction and internal fixation was done with negligible blood loss. Our patients underwent an average stay of 5 days in the hospital with minimum of 2 days and maximum of 8 days. Union in our study was achieved at an average of 9.2 weeks and cases were followed up at 2, 6, 12, 16 weeks. Conclusion: TENS is a good method of choice for paediatric fracture shaft of femur fractures particularly in the age of group of 5-15 years of age as it acts an internal splint without disturbing periosteum, promotes faster bridging and callus formation and finally early mobilization.