Abstract
Background: Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion that can be achieved by either closed reduction and casting or surgical intervention. Number of surgical treatment modalities have been mentioned for unstable pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing
 Methods: This was descriptive cross-sectional study performed from January 2016 to December 2019. A total of 85 diaphyseal pediatric forearm fractures were treated surgically with TENs during this period. Functional outcomes and complications were analysed 6 months after surgery.
 Results: The mean age of patients in our study was 10.67±1.88. There were 50 (64.1%) male and 28 (35.9%) female. Incidence of fracture is higher in left side 47 (60.2%) in comparison to right side 31 (39.8%). Thirteen (16.7%) fractures were in proximal third, 50 (64.1%) in middle third and 15 (19.2%) in distal third of both bone forearm.There were excellent outcomes in 91%, good outcomes in 6.4% and fair results in only 2.6% of patients.Seven different types of complications were noted including skin irritation 8 (10.2%), cortex perforation in 2 (2.5%) and iatrogenic fracture in 1 (1.3%) case.
 Conclusions: Titanium elastic nailing is excellent treatment option for displaced unstable pediatric both bone fractures especially in elderly children. This is technically easy, minimally invasive procedure where bone healing is relatively fast, implant removal is easy with excellent cosmesis of skin without long ugly scar in forearm.
Highlights
Most of the pediatric both bone fractures heal well with closed reduction and casting, some cases require operative intervention.[1,2] Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion
Number of surgical treatment modalities have been mentioned for pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing.[6,7,8]
The purpose of this study was to find out functional outcomes, possible complications and possible techniques of avoiding them in unstable forearm fractures in children treated with titanium elastic nails (TENs)
Summary
Most of the pediatric both bone fractures heal well with closed reduction and casting, some cases require operative intervention.[1,2] Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion. Surgical intervention is advised for displaced both bone fracture with unacceptable alignment, compound fractures, unstable fractures and failure of conservative treatment.[5] Number of surgical treatment modalities have been mentioned for pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing.[6,7,8] Among different surgical methods, flexible intramedullary nailing is relatively better choice because it is minimally invasive, simple, shorter surgical time, promotes quicker bone healing, maintains accurate alignment of bone, gives excellent cosmesis because of lack of long skin incision and implant removal is less invasive.[9,10,11] Even though this technique is not free from complications like implant prominence, skin impingement, bursa formation of skin and migration of implant Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion that can be achieved by either closed reduction and casting or surgical intervention.
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