Elastic Nailing Research Articles

Evaluation of Radiological and Functional Results of Long Bone Diaphyseal Fractures in Children Aged 5-15 Years Who Underwent Titanium Elastic Nail

Objective: In this study, we aimed to evaluate the radiological and functional results of titanium elastic nail (TEN), which was used as a surgical method in pediatric long bone diaphyseal fractures between 5-15 years of age, by comparing it with the clinical features of the patient and the fracture.Methods: In this study, 44 patients (11 girls, 33 boys) aged 5-15 years (mean 9.86 ±2.84) were included. The clinical features of the patient, family satisfaction, evaluation of the fracture according to Flynn Criteria, time to bone union, stay in the hospital, and school absence was examined.Results: TEN was applied mostly to the femur (n;18), tibia (n;14), and forearm (n;12) diaphysis fractures, respectively. Most of the fractures were seen as a result of high energy and closed middle diaphysis, the transverse fracture pattern was the most. Most of the fracture surgeries were performed with the closed method. The family satisfaction of the patients was at a high level. In the evaluation of fractures according to Flynn Criteria, most of the results were excellent, but no poor results were observed. Bone union time was higher in patients aged ten years and older and undergoing open surgery, and less in transverse fracture shape (p<0.05). The time not to attend school was highest in open fracture type, tibia fractures, and open surgery patients (p<0.05). Ulna union time was 13.1 ± 1.8 weeks, which was higher than forearm fractures (p<0.05). The hospital stay was 3.50 ± 0.79 / 4.29 ± 1.54 / 3.33 ± 0.49 days in femur/tibia/forearm fractures, respectively, and was the highest in tibia fractures (p<0.05).Conclusions: TEN is an effective and safe method for long bone diaphyseal fractures in children aged 5-15 years, with low complication rates and positive effects on the patient and the health system.

Pediatric distal third tibial shaft fractures: a comparison of surgical fixation methods and incidence of concomitant physeal fractures.

The purposeof this study was to compare outcomes of operatively treated pediatric distal third tibial shaft fractures fixed with elastic nailing or plate fixation and to evaluate the incidence of concurrent distal tibia physeal fractures. Retrospective review identified skeletally immature patients that underwent operative fixation of distal third tibia fractures at a level 1 children's hospital from 2010 to 2020. Patient and fracture characteristics were recorded. Analysis of treatment outcomes was performed and rates of concurrent distal tibia physeal fractures were evaluated. Of the 214 surgically treated tibial shaft fractures, 43 were distal third fractures. A concurrent distal tibia physeal fracture was present in 32.6% of patients. These were significantly associated with spiral distal third tibial shaft fractures. The presence of concurrent physeal fractures did not affect patient treatment outcomes. Comparing elastic nailing versus open reduction and plating revealed no difference with time to fracture union, time of postoperative immobilization, or time to full weight-bearing. While elastic nailing was associated with increased coronal angulation, translation, and shortening of fractures on initial postoperative imaging, there was no difference in rates of malunion at final follow-up. In our series, there were no differences in treatment outcomes based on fixation method. Our operatively treated distal third tibial shaft fractures had a higher rate of associated distal tibial physeal fractures than previously published in the pediatric orthopedic literature. We recommend careful evaluation of the ankle for concurrent physeal injuries in patients with distal third tibial shaft fractures indicated for operative treatment. Level of evidence: level III therapeutic study - retrospective comparative study.

Paediatric Femoral Diaphyseal Fractures in a South Wales Tertiary Centre: An Account of Trend in Management and Complications Over 16 Years.

Femoral shaft fractures in children have seen a number of interesting developments over the past 20 years. This is a retrospective cohort study looking into epidemiological and outcomes data of femoral shaft fractures in children treated at a tertiary centre in Wales from 2005-2021. Over a period of 16 years, there has been a significant increase in the number of rigid or elastic nailing and submuscular plating, coinciding with a dramatic reduction of external fixation for definitive treatment of diaphyseal femoral fractures. All patients above five years of age underwent operative fixation, with elastic or rigid intramedullary nailing the treatment of choice. Following multiple linear regression with 16 possible explanatory factors, this study found a statistically significant increase in time to union for open fractures, pre-operative translation, and operation time. Furthermore, there was a significant increase in post-operative leg length discrepancy for right versus left-sided fractures. Overall complication rates were 4% for minor and 8% for major complications. Complication rates were lowest for rigid intramedullary nailing and highest for external fixation. No cases of avascular necrosis were found for 27 rigid intramedullary nails inserted. Overall this study reports treatment choices and outcomes in keeping with current trends in management for paediatric femoral shaft fractures.

Comparative study of two elastic fixation systems in single-segment lumbar disc herniation surgery for nucleus pulposus extraction

To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration. A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation, the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group, including 18 males and 15 females, aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group, including 16 males and 15 females, aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time, intraoperative blood loss, postoperative wound drainage, and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared before and 3, 12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard. All the patients successfully completed the operation, and were followed up. The operation time, intraoperative blood loss, postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min, (89.55±16.07) ml, (81.67±16.00) ml, (3.45±0.75) d , while in the elastic nail group was (62.96±11.54) min, (88.35±17.14) ml, (82.29±15.40) ml, (3.29±0.78) d, the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS, JOA score and ODI between the two groups before and after surgery (P>0.05). At 12 months after operation, there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(P>0.05), and there was no significant difference between the groups before and after the operation. According to Macnab criteria, the elastic rod group was excellent in 30 cases, good in 2 cases, fair in 1 case, while the elastic nail group was excellent in 29 cases, good in 2 cases, fair in 0 cases, and there was no significant difference(Z=-0.42, P=0.68). In fenestrated nucleus pulposus extraction for lumbar disc herniation, the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short, and the elastic rod cannot be placed or is difficult to be placed, and it is more widely used.

Upper Limb Salvage Surgery Due to Explosion Using Vacuum-Assisted Closure: A Case Report

High trauma injuries of the forearm frequently present with complex bone and soft tissue defects. Early repair is required to retrieve the extremity and restore its function, As the advance of surgical repair and reconstruction technology, limbs damaged by high energy trauma that might have needed to be amputated in the past can now be saved by surgical reconstruction
 This is a case report of 36 year old man with left upper limb injury after high energy explosion trauma where a large soft tissue defect of the forearm with exposure of the vital structures and fracture of the ulna and radius and the fracture of radius and ulna were fixed by Elastic Nail to maintain their alignments and length, and put a cerclage on the fracture site of the radius to hold a fragment. The large soft tissue was reconstructed by a primary tendon and muscle repair, with vacuum assisted closure followed by split thickness skin graft. And at 6 Weaks physıotherapy was started wıth dynamıc hand splınt by slıgthly flexıng the fıngers
 The application of VAC as temporary coverage of large tissue defects in upper limbs supports wound conditioning and facilitates the definitive wound closure.

Posibles factores de riesgo para reducción abierta en fracturas diafisarias de antebrazo en niños tratadas con clavos elásticos intramedulares

IntroductionDiaphyseal fractures of the forearm are common injuries in the pediatric population and can be treated nonoperative. However, there are specific indications for intramedullary fixation with elastic nails with or without open reduction. The objective was to find predictive risk factors for closed reduction failure in children between 5 and 16 years old. Material and methodsDescriptive observational retrospective study, case series type. The database of the pediatric orthopedics of a children's hospital was reviewed from January 2017 to December 2021. Data from medical records and pre-operative radiographs were collected to analyze the possible variables related to closed reduction failure. ResultsA sample of 51 patients were analyzed, the average age was 10.68 years (±2.62), with a prevalence of males (82.35%). Twenty-two patients (43.14%) underwent open reduction, 20 (39.22%) closed, and 9 (17.65%) mixed. None of the variables were statistically significant. However, the angulation of the radius in the lateral X-ray showed a value of p=0.07, which approached statistical significance and could be related to failure in closed reduction. ConclusionThe findings of this paper can help surgeons to make the decision for open reduction, avoiding risks due to excessive manipulation of soft tissues such as compartment syndrome. A study with a larger sample is needed to increase the statistical power to validate predictive risk factors for failure in closed reduction in the management of diaphyseal fractures of the forearm.Level of evidence: IV.

The Floating Knee in Pediatric Patients: A Single-Center Retrospective Study From a Referral Center.

IntroductionAn ipsilateral fracture of the femur and tibia (also known as floating knee) is a rare injury in pediatric patients. Recent advances rapidly made the use of intramedullary elastic nails the standard of care in the management of long bone fractures, including floating knee injuries, in patients with immature skeletons. Currently, we have observed a trend of fixing both fractured bones, thus improving functional outcomes, and reducing sequelae. The aim of this study was to report our experience in the management and functional outcomes of floating knee injuries in a single trauma-I level center.Materials and methodsThis is a retrospective study of consecutive cases from June 1, 2018, to March 31, 2022, from a single trauma center. Preoperative and postoperative records and radiographs were assessed, including the epidemiological data and characteristics of the fractures type of treatment, mechanism of injury, complications, and functional evaluation at the last follow-up, which was performed according to the criteria described by Karlstrom and Olerud.ResultsTwenty-five patients were included during the four years of study, of which 18 were male (72%), and the mean age was 9.6 years. Overall, 96% of the cases were related to traffic accidents. An analysis of the provided treatment showed that 19 cases (76%) were resolved with surgery on at least of the bones, and six cases were managed with simultaneous orthopedic treatments in both injuries. Excellent outcomes were achieved in 15 cases (60%), good outcomes in three, fair outcomes in five, and poor outcomes in one. Concerning the classification of injuries according to the criteria developed by Letts and Vincent,it was observed that type D was the most frequent one. With regard to exposed bone injuries, 15 cases presented with open fractures. Complications were found in eight (32%) cases, of which five were related to limb discrepancy and three with functional limitations of the knee, with changes in its range of motion. There was also one case of nonunion of the distal tibia.ConclusionTraffic accidents are the main cause of floating knees. Surgical management of the fractures brought satisfactory outcomes and reduced complications. Thus, fixation of injuries is recommended for early return to daily activities and for a reduction in residual complications.

Treatment of Diaphyseal Fractures of the Femur in Paediatric Age Group: A Comparative Study of Locking Compression Plate Versus Titanium Elastic Nailing System (TENS).

Background: Diaphyseal femur fractures are commonly seen in the paediatric age group as there is an increase in the incidence of road traffic accidents. Titanium elastic nailing system (TENS) and plating are the common methods used for paediatric long bone fracture fixation. The purpose of our study was to evaluate and compare functional and radiological outcomes of paediatric femur diaphyseal fractures treated with locking compression plates and with TENS.Methods: Our study included 59 patients diagnosed with femur shaft fracture. Twenty-eight patients included in group one underwent open reduction and internal fixation with locking compression plates and 31 patients in group two underwent open reduction/closed reduction with intramedullary TENS. All post-operation patients were evaluated at four, eight, 10, 12, 16, 20, 24, and 36 weeks. The functional outcome was assessed based on the Flynn scoring system and radiological union based on fracture union on X-ray.Results: We analyzed our data using the Flynn scoring system. In group one, out of 28 cases treated with locking compression plates, 25 (89%) were excellent, two (7.5%) were satisfactory, and one (3.5%) was poor. In group two, out of 31 cases treated with intramedullary TENS, 26 (83.8%) were excellent and five (16.2%) were satisfactory. In our study, the average union time in group one was 11.4 weeks and in group two was 14.41 weeks. Fracture union was 100% in both groups.Conclusion: In our study, we noted that the union of the femur shaft was early with the use of locking compression plates. In TENS, there was less intraoperative blood loss, very minimal postoperative scar, and less soft tissue damage. Also, implant removal was easier compared to locking compression plates.

Short Term Clinical, Functional and Radiological of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail in Paediatric Patients

Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

Management of both bone forearm fracture using titanium elastic nailing system in pediatric age group

Background: The management of pediatric forearm fracture has been a dilemma to surgeon. Conservative treatment with cast still is the preferred treatment. Never the less old children and proximal fracture warrants some form of internal fixation. Aims and Objective: The aims of this were to analyze the role of titanium elastic nailing system in fixation of pediatric forearm fractures and its associated complications. Materials and Methods: Over 3 years, 103 patients were enrolled in our institute. After obtaining consent and preanesthetic check-up, patients were scheduled for surgery, where internal fixation was done using titanium elastic nailing system. Patients were followed up every month for 3 months and then every 3 months interval for 8 months. The time to union and functional score were assessed using modified Flynn score. Results: Among the 103 patients, 63 (61.16%) were in the age group of 7–13 years. Mean age was 11.72±3.50 years (range 4–18 years). Seventy-eight (75.72%) patients were male and fall from height was the most common 66 (64%) mode of injury. Radiological union occurred in most 54 (52.42%) of the patients at average 5–7 weeks. As per the modified Flynn criteria, 82 (79.61%) cases had excellent functional outcome, 11 (10.67%) cases good, 4 (4.12%) fair, and 6 (5.82%) had poor outcome. Neuropraxia was seen in 8 (7.76%) cases and rupture of extensor pollicis brevis was seen in 4 (4.12%) patients and treated accordingly. All the patients regained full functional recovery. Conclusion: TENS is an effective, safe, reliable, and easily reproducible technique for the management of pediatric forearm fractures. It has advantage of preserving the fracture hematoma, providing relative stability to ensue early rehabilitation and minimally invasive nature.

Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures

To explore the clinical effect of Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures. A total of 34 children with irreducible subradial 1/3 fractures treated by surgery from August 2016 to December 2020 were retrospective analyzed. Among them, 16 cases underwent Kirschner wire retractor-assisted closed reduction and percutaneous elastic intramedullary nailing with inverted insertion(observation group), 10 males and 6 females, aged from 4 to 10 years old with an average of(6.0±0.4)years;18 cases underwent open reduction and plate internal fixation (control group), 11 males and 7 females, the age from 3 to 10 years with an average of(7.0±0.5) years. The operation time, intraoperative blood loss, hospital stay, incision length, fracture healing time and complications of the two groups were observed and the wrist function was evaluated by Cooney wrist joint score. All patients were followed up for 3-12 years old with an average of (11.40±0.48) months in the observation group and 4-13 months with an average of (11.50±0.39) months in the control group. Bone healing was achieved in all patients, and there was no incision infection in both groups. The operation time, intraoperative blood loss, hospital stay and incision length in observation groups were lower than those of control group (P<0.05). There was no significant difference in the fracture healing time between two groups(P>0.05). There was no significant difference in postoperative healing and recovery of wrist function between groups(P>0.05). Compared with open reduction and plate internal fixation, Kirschner wire retractor-assisted reduction and percutaneous elastic intramedullary nail fixation for irreducible subradial radial 1/3 fractures has the advantages of less trauma, shorter operation time, less blood loss, and satisfactory short-term clinical results.

Study of outcome of pediatric shaft of femur fracture treated with Titanium elastic nailing system

Study of outcome of pediatric shaft of femur fracture treated with Titanium elastic nailing system

TITANIUM ELASTIC NAILING SYSTEM IN MID-SHAFT CLAVICLE FRACTURE- A PROSPECTIVE STUDY.

Introduction: Young and active persons are liable for clavicle fractures, most common among Racing individuals ,sports persons and in athletes due to high velocity injury. Clavicle fractures are about 2.5% of all fractures and it is the most common .Satisfactory results with high union rates and less complications have been reported from various techniques for operating Clavicle fractures .The clavicle is a long bone with broad medial and at lateral end and is treated best with Intramedullary elastic devices. So, titanium elastic nailing system is the recommended procedure for all displaced midshaft clavicle fractures to reduce the rate of malunion , non-union, delayed union , symptomatic malunion, and Other complications. Aim Of The Study: To analyze the functional outcome of displaced middle third clavicle Fractures treated by titanium elastic nailing system that will keep the Anatomical shape and length of the clavicle. The study was provisionally approved by the institutionalMaterials And Methods: ethics committee, Andhra medical College, visakhapatnam. This prospective study of displaced midshaft Clavicle fractures treated by titanium elastic nail system was done at the Department of Orthopedics, King George Hospital, Andhra Medical college, Visakhapatnam, from September 2019 to September 2021. Over a period of 2 years with in my academic years from may 2019 to may 2022. Titanium elastic nailingConclusion: system for displaced midshaft clavicle fracture is a safe minimally invasive technique with good functional and radiological outcomes and has better cosmetic appearance . Clavicular fractures which are displaced at middle third are best treated with titanium elastic nailing system with less operative time of 30-45 minutes compared with clavicular plating which takes more than 60-90 minutes. This procedure has better functional outcome than conservative treatment . A good reliable sophisticated minimally invasive technique for midshaft clavicular fractures are xed by Closed nailing or minimal open reduction at fracture site.

Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures-A 10 Year Review.

Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.

Outcome of Pediatric Patients with Fracture of Femur Fixed with Intramedullary Elastic Nail

Objective: To determine the effects of elastic intramedullary nails used for fixation of femur diaphyseal fractures in paediatric patients. Method: This prospective observational research was done from April 2020 to June 2021. 52 paediatric patients diagnosed with femur diaphyseal fractures with mean age from 6 to 12 years were enrolled in this study. All patients were admitted and subsequently operated for treatment of femur fracture using elastic intramedullary nail in retrograde fashion. Patients were in structured follow up till radiological union realized. Flynn scoring criteria was applied to evaluate the functional outcomes at 6 months after surgery. Results: The average age of patient enrolled was 9 years (6- 12 years), all 52 patients were in follow up for average 26 weeks (14-36 weeks). Fracture union was observed in all operated children in mean time of 9 weeks (range 6-12 weeks). Four participants suffered superficial skin infection at entry site. Two patients had limb length discrepancy upto1.5cm and two patients had varus angulations up to (10º) and in two patients proximal migration of nail was noted. According to Flynn Criteria outcome was excellent in 38 patients (73.1%), satisfactory in 12 patients (23.1%), poor in 2 patient (3.8%) respectively Conclusion: Fixation of femoral diaphyseal fracture with intramedullary elastic nail in paediatric patients is better option. One can achieve excellent results, satisfactory radiological and clinical bony union, with lowest complication rate, so it could be regarded as a favorable fixation implant for management of diaphyseal femur fractures in pediatric age group. Keywords: Fracture, femur shaft, elastic intramedullary Nail, Paediatric patients.

Titanium Elastic Nailing System of Diaphyseal Femur Fracture in a 7 Years Old Child: A Case Report

Objective: Midshaft femur fracture commonly treated conservatively in paediatric patients. However, complications are seen in conservative treatments and lately surgical interventions are being practised tremendously to minimise the complications. Case Report: A 7 years old boy, sustained a closed fracture midshaft left femur after a motor vehicle accident. Operative management was decided for this patient using Titanium Elastic Nailing System, which revealed a good outcome within 3 months of duration. Conclusion: Titanium Elastic Nailing System is fixed with minimally invasive techniques in children 6-16 years of age with diaphyseal femoral fractures, which gives a good outcome and minimizes the complications and allows earlier rehabilitation and return to school life by speeding up the fracture healing. However, an experienced surgeon and good surgical technique is desired to minimize the complications that may occur.

Study on outcome of treatment of paediatric femoral shaft fracture by titanium elastic nails

Background: Although the incidence of paediatric femoral shaft fractures is about 1.6%, it’s treatment is controversial, especially in children of age 6-12 years. Materials and Methods: This prospective observational study was performed at Sher E Bangla Medical College Hospital, Barishal, Bangladesh from January 2020 to December 2020, on 7 children (n=7). There were limited number of patients included due to this study accomplished in the perphery city of Bangladesh. Both male and female children with simple transverse and short oblique fractures were included. Results: Among the 7 cases, 6 were closed femoral shaft fracture and 1 was Gustilo Anderson type 1 open fracture. The mean age of the patients was 8.57 years, ranging from 5-13 years. 6 were male and 1 was female, with a male female ratio of 6:1. In 4 cases right side was affected and in 3, left side was affected. 5 cases were treated by closed reduction and the rest 2 cases were treated by open reduction. The average union of fracture was 9.7 (6-15) weeks. Results were evaluated using Flynn et al scoring criteria, with 4 excellent, 2 good and 1 poor outcome during the 5-11 months follow up period. Conclusion: Titanium elastic nailing has considerably decreased the period of immobilization, ensured early return to normal life and provides psychological advantages. It provides better outcome in simple transverse of short oblique mid diaphyseal femoral fractures.

Functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm

Background: Excellent results for plate fixation in displaced diaphyseal fractures of both bone of forearm have been reported by various authors, but only a few authors have focused on plate fixation in the management of open diaphyseal fractures of both the radius and ulna. Aim: This present study is aimed to assess the functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm. Methods: This series consists of 50 cases of fracture both bone of forearm by open reduction and internal fixation with dynamic compression plate, closed reduction with intramedullary nailing by TENS between the period of 2 years at a tertiary care hospital after obtaining the clearance by the hospital ethical committee. Of the above cases 25 patients were treated by open reduction and internal fixation with dynamic compression plate and 25 cases were treated with closed reduction and internal fixation with TENS. Results: Even though, plate osteosynthesis is still the most commonly used form of fixation in adult both bone forearm fractures, both titanium elastic nail and interlocking nail fixation are relatively newer techniques which offer a viable and more efficient alternative especially in fixation of fractures involving shafts of radius and ulna. Conclusions: Increased incidence of forearm fractures was probably due to increasing road traffic accidents and fall. Forearm fractures occurs more commonly in second and third decade. Male predominance was seen. Open reduction and internal fixation can be considered as the treatment of choice if there is no contraindication. It is important to maintain length, opposition, axial alignment, and rotational alignment in order to restore good range of movement of forearm. This is achieved in the present study.

Clinical outcomes of titanium elastic nailing system for middle third clavicular fracture

Aim: Clinical outcome of displaced middle third clavicular fracture using intramedullary fixation by titanium elastic nail. Materials and Methods: 20 cases of displaced middle third clavicular fracture underwent closed reduction internal fixation with Intra medullary fixation by titanium elastic nail. The study was conducted from July 2020 to August 2022 admitted to Narayana Medical College and hospital, Nellore. We evaluated the Constant score to determine the outcomes.Results: All fractures got united in our study. Average time taken for full clinical and radiological union was 11.8 weeks (Range 10- 14 weeks).There were no major complications noted. Average Constant Score at final follow up was 95.16.Conclusion: Minimally invasive fixation with TENS is a safe method and can be performed with minimal complications. This method of fixation of displaced middle third clavicular fractures should result in less soft tissue injury, shorter operating time, satisfactory stabilization, a good cosmetic appearance, quick pain relief, early return to work and easy implant removal under local anaesthesia as an outpatient department procedure.

Closed reduction and titanium elastic nailing in diaphyseal femoral and tibial fractures in children

Purpose: The aim of this study was to evaluate clinical and radiological results of children who were treated using titanium elastic nail (TEN) for femoral and tibial diaphyseal fractures.&#x0D; Materials and Methods: A total of 49 (15 female, 34 male) femur shaft fractures (FF group) and 35 (12 female, 23 male) tibial shaft fractures (TF group) were retrospectively analyzed. Time until the operation (in days), duration of hospital stays (in days), time to union (in weeks), and the time to implant removal (in months) were recorded. In the final follow up; limb length discrepancy (mm), angulation, restrictions in the range of hip and knee joint motion were measured. Flynn Score was used for clinical results.&#x0D; Results: The mean age was 7.96 in the FF group and 9.34 in the TF group. The mean follow-up time was 51.3 months in the FF Group and 58.3 months in the TF group. The mean duration of hospital stay was 1.4 days in both groups. The mean time for bony union was 9.7 weeks and 10.7 weeks for the FF and the TF groups, respectively. The mean time to implant removal was 7.1 months and 6.22 months for the FF and the TF groups, respectively. Flynn scores were poor in 3 patients, successful in 6 patients and excellent in 40 patients in the FF group; whereas it was poor in 1 patient, successful in 2 patients and excellent in 32 patients in the TF group. None of the patients had major complications. Bony union was achieved in all patients. &#x0D; Conclusion: Intramedullary fixation using TEN is a successful treatment method with satisfactory clinical results and low complication rates for pediatric femoral and tibial diaphyseal fractures.