Elastic Intramedullary Nailing Research Articles

Functional outcome of elastic intramedullary nailing of forearm fractures in children using pin leverage technique

<p class="abstract"><strong>Background:</strong> There is a recent trend towards elastic intramedullary nailing in fixation of pediatric forearm bone diaphyseal fractures. But in children we should always attempt closed reduction and immobilsation in a moulded plaster cast. Irreducible, open fractures and those that get redisplaced in moulded plaster cast need operative fixation with intramedullary nailing. Our aim was to know the outcome of tens nailing in such fractures.</p><p class="abstract"><strong>Methods:</strong> We studied functional and radiological outcome of elastic intramedullary nailing by pin leverage technique in forearm fractures in 34 children. The study was done at a tertiary care centre in Uttrakhand, India from May, 2016 to July, 2018. Inclusion criteria were closed forearm fractures; diaphyseal fractures; age 1 to 19 years. Exclusion criteria were open type 2 and type 3 Gustillo-Anderson fractures; metaphyseal, epiphyseal forearm fractures; age >19 years; pathological fractures.<strong></strong></p><p class="abstract"><strong>Results:</strong> Closed reduction and percutaneous pin leverage technique for reduction was successful in all but 4 patients where limited open reduction was used for reduction of fracture fragments. All fractures united radiologically between 7 to 13 weeks with mean distribution of 9.2 weeks. For functional outcome we used modified Price and Daruwala’s score. 28 patients showed excellent results and 6 patients showed good results. All our patients had radiological union in mean of 9.2 weeks (7-13 weeks).</p><p><strong>Conclusions:</strong> Fixation with intramedullary TENS nailing is an effective and affordable way of treating patients in paediatric age group.</p>

Radial neck fractures in children: A surgical tip using the Metaizeau technique to improve stability of the reduction

AimTo evaluate early results of management of radial neck fractures with Métaizeau technique in the paediatric age group and to elaborate on a surgical tip to improve stability of the fixation. MethodA retrospective analysis of 21 patients, with fracture radial neck, who underwent closed reduction and internal fixation with elastic intramedullary nailing (Métaizeau technique), was performed. Mean age at injury was eight years, and the average follow-up was 4.5 months (range: 3–6 months). Follow up Clinical and radiological evaluation was performed at first and sixth postoperative weeks. At six weeks following removal of the nail, a clinical assessment was conducted to record the outcomes, and any later follow-up was arranged based on pain and range of motion. ResultsWe recorded five excellent, eight good, one fair, results for type 3 fractures. For type 4 fractures, we had one excellent, five good and one fair, results. Altogether, we recorded 20 (90.5%) excellent or good results, and 2 (9.5%) fair results. Complications noted were superficial skin infection at the entry site in one patient that required a course of oral antibiotics. Prominent metal work was noticed in 14 cases, which didn't need any further intervention as it did not cause any functional discomfort. ConclusionWith Metaizeau technique, there were reported poor results of about 10% in literature. In our study, with the modification of the shape of the nail tip, we have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes.

Comparison of curettage and bone grafting combined with elastic intramedullary nailing vs curettage and bone grafting in the treatment of long bone cysts in children.

To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non–elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.

Treatment of long bone cyst in children by autologous bone marrow blood injection and elastic intramedullary needle

To observe the clinical effect of autologous bone marrow blood injection combined with elastic intramedullary needle implantation in the treatment of long bone cyst in children. From January 2010 to December 2015, 29 children with long bone cyst were treated with autologous bone marrow blood injection combined with elastic intramedullary nail implantation, including 22 males and 7 females, aged 2 to 12 years old with an average age of 7.7 years old, and the course of disease was 12 to 84 months. Among them, 17 cases were proximal humerus, 9 cases were proximal femur, 2 cases were distal femur and 1 case was proximal ulna. All children with bone cyst underwent preoperative X-ray examination and CT or MRI examination if necessary. After definite diagnosis, bone marrow blood injection combined with elastic intramedullary needle support and drainage were used as treatment methods. After operation, multiple X-ray examination and follow-up were carried out. The curative effect was evaluated with Capanna bone cyst treatment evaluation criteria. Twenty-seven of 29 children were followed up for 12 to 60 months with an average of 31.8 months. According to the evaluation criteria of Capanna bone cyst, 26 cases were cured and 1 case was partially healed with residual lesions. Autologous bone marrow blood injection combined with elastic intramedullary needle has the characteristics of definite curative effect, high cure rate, fewer complications and objectively controllable treatment process for simple long bone cyst in children.

Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails

Objective To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. Methods From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. Results The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. Conclusion The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children. Key words: Child; Forearm; Fractures,bone; Intramedullary nails

Research progress in complications following elastic intramedullary nail treatment for long bone fracture of extremities in children

The elastic stable intramedullary nailing (ESIN) technique is widely accepted by pediatric orthopedic surgeons for the following advantages: being minimally invasive, non-destructive on epiphyseal function, easy, rapid postoperative recovery, allowing early functional exercise and having low complication rate. It has become the mainstream technique for the treatment of long bone fractures in children. Although the concept of minimally invasive surgery for children with long bone fractures is constantly evolving and the surgical technique is becoming more and more mature, there are still some complications after ESIN operation, such as tendon and iatrogenic nerve injury, soft tissue irritation and infection, poor alignment after fracture or re-shift, delayed union and non-union, leg-length discrepancy, rotation and angular deformity, osteofascial compartment syndrome, and other clinical problems. These complications often occur due to the negligence of important biological principles, obvious technical errors and the negligence of the characteristics of local anatomy. The authors review the problems of ESIN technique in the treatment of humeral fractures, radius and ulna fractures, femoral fractures and tibial fractures of children, seeking to avoid the complications as much as possible and giving full play to the minimally invasive advantages of ESIN. Key words: Fracture fixation, intramedullary; Child; Postoperative complications; Elastic stable intramedullary nailing

Elastic intramedullary nailing of the femur fracture in patients affected by osteogenesis imperfecta type 3: Indications, limits and pitfalls

IntroductionPatients with Osteogenesis Imperfecta (OI) Type 3 may exhibit both primitive deformities and secondary fracture malunions on a femoral level. The orthopaedic surgeon’s objective is to cure the deformities in order to prevent fractures and to treat the fractures in order to prevent deformities, by using telescopic nails as the gold standard method of fixation. However, the titanium elastic nail (TEN) is indicated as a possible alternative in certain selected cases. Materials and methodsThe Centre for Congenital Osteodystrophy of the Sapienza University of Rome follows 485 patients with osteogenesis imperfecta. For the purpose of this study, we selected 36 patients with OI type 3 (15 females and 21 males), aged between 2 and 10 years old, who were surgically treated for femur fractures with Titanium Elastic Nail (TEN) from January 2007 to December 2009. In 12 cases a single TEN was implanted, while 24 of the cases were treated by implanting 2 TENs with the Sliding Nail (SN) technique. A retrospective evaluation was carried out by analysing the data from the medical charts and dossiers related to pain symptoms, knee and hip Range of Motion (ROM), any possible complications that could cause implant revisions (infections, nail slide failure, nail migration, traumatic events following surgery, delayed consolidation, epiphysiodesis). ResultsAt the 60th post-surgical month, the revision rate was 75%, mostly due to migration, osteolysis, nail slide failure and nail fracture. The Kaplan-Meier's survival curve analysis showed a coefficient of 0.25–60 months (confidence interval −0.31 and 0.81). DiscussionThe percentage of complications and the high rate of revisions recorded in our sample confirm that telescopic nail is the gold standard in the treatment of femoral fractures in patients with OI type 3. ConclusionsIn patients under the age of 4, with narrow medullary canals, low life expectancy, few to nil rehabilitative prospectives or severe comorbidities, the use of TEN may be considered as a less invasive approach compared to telescopic nail surgery, however only temporarily, as it will still most probably require a surgical revision a few years down the line.

Efficacy of titanium elastic intramedullary nail for treatment of clavicular shaft fractures in young and adolescent patients

From January 2012 to January 2017, 98 patients with clavicular fractures were treated with titanium elastic intramedullary nail(TEN), including 58 males and 40 females with an average age of 14.5 years (11-18 years).The mean time from injury to surgery was 4.2 d (2-7 d).Sixty nine cases were treated by closed reduction and 29 cases by 2-3 cm incision. Constant function scores and disability of the arm shoulder and hand (DASH) scores were compared before surgery and 4 wks after surgery; Neer function scores at 3 months after surgery were compared between the injured side and unaffected side. All patients were reexamined at a mean follow-up of 6.5 months (3-8 months), and fracture union was determined by X-ray.The results showed that the bony union was ranged from 8-16 weeks with an average of 12.4 weeks. There were 4 cases with soft tissue irritation; no cases of infection, TEN broken, delayed healing were observed. The Constant score rose from 41.7±4.8 before operation to 92.6±3.2 at 4 weeks after operation (t=16.67, P 0.05). The TEN was removed after showing bone healing on X-ray film. The study indicates that using TEN has advantages of less invasiveness, reliable fixation and rapid functional improvement of shoulder for treatment of clavicular fracture in young and adolescent patients. Key words: Clavicle; Fractures,bone; Adolcscent; Fracture fixation,intramedullary

Proximal Metaphyseal and Diaphyseal Humerus Fractures

Pediatric humeral proximal metaphyseal and diaphyseal fractures are mostly caused by trauma. Pathological fractures and stress fractures should always be ruled out. Nonoperative treatment is the preferred modality of treatment for most of these fractures. Operative treatment is indicated for open fractures, vascular injuries or if adequate functional reduction cannot be maintained. For pediatric proximal humeral metaphyseal fractures, percutaneous pinning and flexible intramedullary nailing may be necessary, both of which are reported to have good outcomes. For humeral diaphyseal fractures which cannot be managed nonoperatively, elastic intramedullary nailing or plate and screw fixation can be used with good outcomes. These methods of fixation are usually associated with low complication rates. Complications are mainly related to skin and soft tissue irritation by pins or nails or radial nerve injury. External fixation can also used for open fractures with extensive soft tissue injury. While postoperative stiffness is feared complication after surgical fixation of humeral fractures in adults, it is not a common complication after fixation of pediatric fractures. Similarly, nonunions and malunion requiring corrective osteotomy are not common.

Percutaneous Pinning of Pediatric Proximal Humeral Fractures.

Proximal humeral fractures are relatively common in pediatric patients. These injuries are usually treated nonoperatively in younger children or children with minimally displaced fractures. However, closed reduction or open reduction followed by percutaneous pinning is recommended for older children with displaced fractures. Percutaneous pinning has several advantages, but there are limited reports of a safe and reliable surgical technique in the literature. Patients are positioned in a modified beach-chair position to allow orthogonal imaging. The injured extremity is draped free from the remainder of the body. Closed reduction, which comprises a combination of traction, abduction, and rotation, is attempted. Internal or external rotation may be required, depending on the fracture line and deforming forces. If an anatomic closed reduction cannot be obtained, a block to reduction should be suspected and open reduction should be performed via a deltopectoral approach. Once the fracture is reduced, two 2.5-mm threaded Kirschner wires from the small external fixator set are used to percutaneously fix the fracture. Any small external fixator set can be used, and if not available, individual threaded wires of similar size can be used. Alternatively, Kirschner wires can be advanced to the fracture site prior to reduction and then advanced into the humeral epiphysis once the fracture is reduced. Care is taken to avoid the axillary nerve, which is reliably within 6 cm of the anterolateral aspect of the acromion, and wires are placed distal to this site. Once pin position has been confirmed radiographically, the construct is secured with pin-to-pin clamps to improve rigidity and further decrease the risk of pin migration. A soft dressing and shoulder immobilizer are placed postoperatively. Patients are followed with biweekly radiographs, and pins are removed in the outpatient office or under conscious sedation at 4 weeks. Leaving pins for a longer period may increase the risk of skin irritation and potentially infection. Alternatives to closed reduction or open reduction and percutaneous pinning include nonoperative management and elastic intramedullary nailing. Nonoperative treatment is a reliable option for most patients. However, it is not suitable for older children with severely displaced fractures because of diminished remodeling potential. Elastic intramedullary nailing is a good option for distal fractures. However, it is not suitable for proximal fractures, and it has been associated with longer operative times and more blood loss than percutaneous pinning. It also requires a second procedure. This procedure allows for anatomic fixation of proximal humeral fractures and provides a rigid construct to maintain reduction. It is not technically challenging, requires limited postoperative immobilization, and decreases the risk of a second general anesthetic.

Atypical use of pediatric flexible nails in the treatment of diaphyseal fractures in adults.

Background and aim of the work:Elastic intramedullary nails are commonly used for the treatment of diaphyseal fractures in adolescents and children. The major advantages are the minimally invasive nature of the technique, the short operation time, and the preservation of the growth plate and periosteum thus allowing bone healing within a closed and intact biological environment. Elastic nails are rarely applied to the adult fractures.Methods:Five selected adult patients affected by diaphyseal fractures were treated using paediatric flexible nails T2 Kids (Stryker®, Mahwah, NJ, USA) as consequence of their poor clinical conditions, high risk of neurovascular injuries and skin/soft tissues problems. All patients were monthly clinically and radiographically evaluated after surgery until fracture healing.Results:Radiological and clinical outcomes were satisfying. All fractures healed after a mean period of 3 months. No losses of reduction as well as mobilization/breakage of implant were observed. Conclusions: Use of pediatric elastic nails is a valid surgical option in treatment of diaphyseal fractures in selected adult patients who request fast and minimally invasive surgery as consequence of precarious clinical or soft tissues conditions. (www.actabiomedica.it)

Comparison of three surgical treatment options for unicameral bone cysts in humerus.

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level of Evidence: Level III - therapeutic retrospective comparative study.

Comparison of efficacy between internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture.

Objective:To compare and analyze the clinical effects of internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture.Methods:A total of 120 children with femoral shaft fractures who were admitted to our hospital from December 2016 to April 2018 were enrolled. The children were divided into an observation group and a control group by random number table, with 60 children in each group. The children in the observation group underwent internal fixation of minimally invasive elastic stable intramedullary nail, while those in the control group underwent open reduction based on internal fixation of plate. The surgical status and postoperative complications of the two groups were observed and compared, and Kolmert knee function scoring criteria were used for assessing the surgical effects of children.Results:The operation duration, intraoperative blood loss, hospitalization duration, fracture healing time and time of off-bed loaded activity of the observation group were significantly shorter than those of the control group, and the differences were statistically significant (P<0.05). The excellent and good rate of fracture healing in the observation group was 100%, which was higher than that of the control group, 83.33%, and the difference was statistically significant (P<0.05). The total incidence rate of complications in the observation group was 8.33%, which was lower than that of the control group, 10.00%, but the difference was not statistically significant (P>0.05).Conclusion:Pediatric femoral shaft fractures can be treated with internal fixation of minimally invasive elastic intramedullary nail, and it has advantages of significant curative effect, small trauma and fast postoperative recovery, which is conducive to fracture healing and worth promoting.

Are stainless steel elastic nails the solution to heavier children with femoral shaft fractures?

Background: The use of titanium elastic intramedullary nails for the treatment of femoral shaft fractures, in children weighing ≥45 kg, has been questioned due to the increased rates of malunion. Our aim was to see if the mechanical properties of stainless steel elastic nails provided enough fracture stability to justify their use in heavier children. Materials and Methods: Twenty pediatric femoral Sawbones®, fixed with titanium or stainless steel elastic nails, were tested. The bending stiffness and moments of the constructs were calculated at increasing loads, along with the angle of fracture deformation. From these estimates of maximum permitted body weight for each nail type were extrapolated. Results: Steel nails created significantly stiffer constructs than titanium in both the coronal and sagittal planes (P < 0.0001). Steel nails allowed bigger sagittal bending moments before losing acceptable alignment, compared to titanium (P < 0.0001). However, in the coronal plane, the difference was not statistically significant (P = 0.457). The estimated body weights extrapolated in the sagittal plane were 45 and 61 kg, in titanium and steel, respectively. In the coronal plane, they were 42 and 44 kg. Discussion: As steel has nearly twice the Young's modulus of titanium, it seems logical that fractures fixed with steel nails would be stiffer and fail at higher loads. However, it is unclear why steel did not outperform titanium in the coronal plane. A theory was proposed that unequal nail slip from the insertion sites might be a contributing factor to these findings. Conclusion: Pediatric femoral shaft fractures fixed with elastic steel nails provide significantly stiffer constructs than those fixed with titanium. However, there is an increased risk of malunion in the coronal plane, in children weighing ≥45 kg, regardless of material used, possibly due to unequal nail slip at the distal entry points.

Damages of locomotor apparatus in children as a result of road accidents

Aim. To study the specific features of locomotor apparatus injuries and to improve the surgical tactics of treatment using low invasive osteosynthesis techniques in case of road accidents among children.&#x0D; Materials and methods. The results of surgical treatment of 35 children (age range 2 to14 years) after road accidents were studied at the pediatric traumatology and orthopedics unit. Associated multisystem injuries of the locomotor system constituted 77,1 %. Clinicoroentgenological data, MRT and CT indices were studied. Vegetative dysfunction was assessed. All the patients underwent low invasive surgical intervention with minimized surgical approach, including elastic intramedullary nails, closed transcutaneous pin osteosynthesis under electro-optic transducer control, transosseous osteosynthesis.&#x0D; Results. All the patients were operated, 80 % of them were operated during the first day after the admission to the hospital. It resulted in early arrest of pain syndrome, fast normalization of vegetative function, prevented the development of traumatic disease or stopped its manifestations. All the results of surgical treatment were estimated as positive. Insignificant contractures were observed in 2 patients after the distal comminuted fracture of the shoulder with decrease in movement amplitude at the level of elbow joint within 15%; no disability was noted; no slowed consolidation and false joints were registered.&#x0D; Conclusions. Low invasive techniques provide optimal conditions for osseous consolidation and positive functional outcome after road accidents. It is recommended to take into account the status of vegetative functions in patients with associated multisystem injuries.

Numerical Simulation of an Intramedullary Elastic Nail: Expansion Phase and Load-Bearing Behavior.

The Marchetti-Vicenzi's nail is an intramedullary device where six curved nails are kept straight by a closing ring in order to allow their insertion into the medullary canal of a long bone; in a following step, these nails stabilize the fracture due to the ring withdrawal and to the consequent elastic expansion of the nails. Pre-clinical testing of this sort of device is strongly advocated in order to be able to foresee their stability inside the medullary canal and to quantify their stiffening action on a broken bone. In this numerical work, an MB (Multi Body) model of the device has been developed, with the dual purpose of evaluating forces between the bone and the system components during its progressive opening and verifying the behavior of the stabilized bone when it undergoes external loading. Different solutions, for flexible body modeling (discretization with lumped parameters, “flexible body,” “FE Part”), have been analyzed and compared in terms of accuracy of results and required computational resources. Contact parameters have been identified and criteria to simplify geometries and therefore to reduce simulation times have been given. Results have allowed to demonstrate how a moderate lateral force is able to dislocate the fracture and how the final position of the retention nut can be optimized. On the whole, a tool for the pre-clinical testing of elastic intramedullary nails has been given.

Impact of Transphyseal Elastic Nailing On the Histostructure of the Tibia in Growing Animals (Non-Randomized Controlled Experimental Study).

BACKGROUND:The use of intramedullary elastic nailing is a method of choice for prevention of complications in children with osteogenesis imperfecta. However, the morphology of the growing long bones in the conditions created was not investigated.AIM:The purpose of our experiment was to study the impact of elastic intramedullary nailing on the histostructure of long bones in their physiological growth.METHODS:Six mongrel dogs underwent intramedullary elastic transphyseal nailing of the intact tibia with two titanium wires. Six months after nailing, a light-optical microscopic and histomorphometric study of the operated and contralateral tibiae was performed.RESULTS:It was found that asymmetric lesion of the distal physis induces a decrease in the height of the distal epimetaphysis. Adaptive changes in the hyaline cartilage of both articular ends were revealed corresponding to the initial stage of chondropathy. Intramedullary nailing promotes an increase in the thickness of the compact bone and the volume of the trabecular bone.CONCLUSIONS:Elastic transphyseal nailing of the intact tibia has a shaping effect which is expressed by an increase in the volume of spongy and compact bone, adaptive changes in the hyaline cartilage. Asymmetric damage to growth zones should be avoided to prevent deformities.

Elastic stable intramedullary nailing (ESIN) in paediatric femur and tibia shaft fractures: Comparison between titanium and stainless steel nails

IntroductionElastic stable intramedullary nailing (ESIN) is currently considered the gold standard in surgical treatment of femur and tibial shaft fractures in school age paediatric patients. Although elastic intramedullary nails are available in both titanium (Ti) and stainless steel (SS) alloy, titanium nails are most commonly used. Nevertheless, there is still contrasting evidence as to whether the use of Ti nails can offer better outcomes in terms of fracture healing and stability over SS nails. The aim of this study was to compare outcomes and complications of Ti and SS ESIN for femur and tibia shaft fractures in a population of school age paediatric patients. Materials and methodsAll consecutive patients who underwent ESIN for femoral or tibial shaft fracture from June 2012 to May 2015 at our centre were retrospectively reviewed. Standard demographic data were collected. Pre-operative and post-operative X-rays were reviewed, complications were collected from patients charts. Patients were divided in two groups, titanium nails (Ti group) and stainless steel nails (SS group) and outcomes compared between the two. ResultsA total of 34 patients were included (17 patients Ti group, 17 patients SS group) with a total of 14 femur and 21 tibia fractures. Average age at surgery was 9.4 ± 2.5 years in Ti group and 10.4 ± 2.4 years in SS group (p = 0.21). The average time to bone healing was 3 months in Ti group, and 2.8 months in SS group (p = 0.63). At final follow-up (12 months), no patient showed a coronal plane or sagittal plane deformity >10° and >15°, respectively. Complication rate was similar between the two groups (24% Ti group, 22% SS group). ConclusionsWe did not observe any significant difference in terms of bone healing, fracture mechanical stability, return to full activity, and complication rate between Ti and SS ESIN for paediatric femoral and tibial shaft fractures. While Ti nails remain a better choice for patients with metal allergy, SS nails may offer safe, effective, and cheaper alternative to Ti nails in school age femur and tibial shaft fractures.

Comparative study of closed intramedullary elastic nailing vs plate osteosynthesis in diaphyseal fractures of both bones forearm in adults

Background: In the current era, fractures of forearm bones have become more common. The forearm serves an important role in the functioning of the upper extremity. Hence aggressive management through good anatomical reduction and internal fixation of these fractures has become a necessity. Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The purpose of this study was to assess and compare functional results of plating and nailing in fracture stabilization. Aims of Study: 1.To evaluate the results of internal fixation of diaphyseal fractures of both bones forearm treated by plate osteosynthesis and closed intramedullary elastic nailing. 2. To compare the functional results of the two groups treated with plate osteosynthesis and closed intramedullary elastic nailing. Methods: Retrospective and prospective study with the sample size of 20 patients with both bone forearm fractures. 10 patients were treated with dynamic compression plating and remaining 10 with intramedullary elastic nails. Results were assessed by time for union, type of fractures, range of motion of elbow and wrist joint, complications and functional assessment were done by Grace- Eversmann Criteria and DASH questionnaire Results: Average surgery time in plate osteosynthesis group was 70 minutes, and in closed nailing group was 50 minutes. In plate osteosynthesis group radius showed union in 9 (90%) patients and ulna in 10 (100%) of patients, and 1 deep infection in plate osteosynthesis closed nailing group both radius and ulna resulted in 100% union rate. In plate osteosynthesis group there was 1 deep infection, no implant failure, and 1 delayed union. Functional results in plate osteosynthesis group were excellent in 7 of patient, satisfactory in 2 of patients failure in 1. There was no unsatisfactory result in this group. In closed nailing group result were excellent in 7, satisfactory in 2, unsatisfactory in 1 and no failure Conclusions: Our experience indicates that the advantage of closed intramedullary nailing for fractures of both bones forearm are that it allows high rate of osseous union, and it requires less surgical exposure and operative time, less risk of infection than plate osteosynthesis for diaphyseal fractures of both bones forearm in adults. The disadvantage of this system is that post-operative immobilization is required until bridging callus is observed at the fracture site. We conclude that closed intramedullary nailing is not superior to plate fixation but can be considered as an alternative to that method for diaphyseal forearm fractures in adults.

Minimally invasive retrograde insertion of elastic intramedullary nails for displaced clavicle fractures in children

To study the application and effect of retrograde titanium elastic nails fixation for the treatment of displaced clavicle fracture in children under closed reduction. From January 2014 to November 2016, 26 children with displaced fractures of the clavicle were treated by closed reduction and retrograde inserted titanium elastic nails including 14 boys and 12 girls with an average age of 9.2 years old ranging from 7 to 14 years. Time from injury to operation was 2 to 7 days with an average of 2.8 days. Visual analogue score (VAS) was used to evaluate the main complaint pain in all patients before and 2 days after operation. The Neer score of shoulder function between affected side and healthy side at 2 months after operation were compared. All the 26 children were followed up for 6 to 12 months. All cases healed well without infection, broken nails or titanium elastic nails exit complications. All children achieved anatomical reduction, good bony union, and good recovery of shoulder joint activity. The average time of removing nail was 14 to 32(16.25±2.62)weeks. The pain VAS score was significantly relieved 2 days after operation (P<0.05). At 2 months after operation, the Neer score of shoulder joint was 98.46±1.07 in affected side and 98.58±1.10 in healthy side respectively, there was no significant difference between the two groups (P>0.05). Titanium elastic intramedullary nail fixation for the treatment of displaced clavicular fracture in children has the advantages of minimal invasion, no effect on skin beauty, rapid healing of fracture, good recovery of postoperative function, simple nailing and less complications.