Fractures In Age Group Research Articles

Analysis of pediatric diaphyseal femoral fracture treated with titanium elastic nailing system

With many modalities available in literature to treat a pediatric femur diaphyseal fracture, it often creates a debate amongst the orthopedicians to choose a treatment of choice. The frequency of such fractures is increasing over the years due to increasing road traffic accidents. Until recently the conservative management was the preferred method to treat such injuries, however because of advantages such as early mobilization, reduced hospital stay, reduced loss of school days, less psychological impact and better nursing care, Titanium elastic nailing system (TENS) has gained the popularity over last two decades. In north eastern region of India to the best of our knowledge, no such study has been done to assess the functional outcome of TENS in pediatric femur diaphyseal fracture in age group of 6-11 years. Hence we retrospectively analysed the result of pediatric femoral diaphyseal fractures in 32 children (23 boys and 9 girls) in the age group of 6-11 years stabilized with titanium elastic nail (TEN).Results: Using Flynn criteria, outcome was excellent in 90.62% (n=29) children and satisfactory in 9.27% (n=3) children at the final follow up period of 6- 8 months after operation. Patients achieved union over a mean period of 8 weeks. Pin site irritation was found in 12.5% (n=4) patients initially which later subsided with physiotherapy at final follow up (6 months). No cases with superficial or deep infection were reported. No child reported any rotational or sagittal plane deformities.Conclusion: Titanium elastic nailing system provides an effective mode of treatment in pediatric femoral diaphyseal fracture in the age group of 6-11 years with advantages of early mobilization and union.

Outcome of Titanium Elastic Nails in Pediatric Femoral Fractures

Background: Femoral fractures are common fractures in paediatric age group. There are various methods to treat such cases. Titanium elastic nailing is one of them and an established and reliable method for treating these types of fractures. Ideal treatment of fractures in the age group of 5 to 14 years is still a matter of debate as no consensus has been achieved till now.
 Aim of the study: The aim of this study was to evaluate the outcome of using titanium elastic nails (TEN) in pediatric femoral fractures. Methods: This observational prospective study was conducted in in the Orthopedic Department of Shaheed M. Monsur Ali Medical College, Sirajganj, Bangladesh during the period from January 2017 to December 2018. A group of 50 children with femoral fractures selected to treat with titanium elastic nailing were finalized as the study population. All the information along with the outcomes of the participants were collected assessed and disseminated by several tables and charts of MS Office program.
 Result: In 20%, 14%, 4% and 2% cases we found superficial infection, mal-union, deep infection and nail breakage as complication respectively. As the final outcome of this study we found, the results were excellent in 34 patients (68%) successful in 12 (24%) and poor in 4(four) patients (8%) as per the scoring criteria for TEN by Flynn et al. Entry site irritation occurred in 3 patients limb lengthening (<1.5cm) was found in 3 cases both clinically and radiologically, which was clinically insignificant nail removal at 5th month, due to wound breakdown at entry sets in one case. Results were better for children in less than 10 years of age.
 Conclusion: Titanium elastic nailing is the method of choice for the simple pediatrics femoral fractures, as it was minimally invasive and showed good functional and cosmetic results. Surgical technique of this procedure is simple and reproducible. It always allows short hospital stay and quick recovery from pain and it is cast-free.

Retrospective Study of the Mandibular Condyle Fracture in Children and Young Adolescents

The aim of this retrospective study was to investigate etiology, clinical features, and treatment modalities of the mandibular condyle fracture in children and young adolescents. This study was conducted based on medical records and radiographic examinations of 44 pediatric patients. Patients received treatment under diagnosis of mandibular condylar fracture. They were divided into 4 groups according to their age. The involvement of condyle in the mandible fracture occurred in higher percentage in younger age groups. Falling was the most common etiologic factor in all age group, especially in children with age under 7. Condyle head was the most frequent site of fracture in age group of 4-7 whereas fracture tends to occur in lower condylar areas in older groups. In 54.5% of the mandibular condyle fracture, symphysis fracture was accompanied. Teeth injury occurred in higher incidency when condyle fracture accompanied symphysis fracture. Conservative treatments were applied to 43 out of 44 patients.

Functional assessment of diaphyseal femoral fractures in pediatric age group managed by titanium elastic nail system: A prospective study

Background: Femoral shaft fractures are common childhood injuries and are among common causes for hospitalization in children. Treatment varies with child's age. There is little room for question in treatment guidelines in children below the age of 3 years, but in the age group of 4–14 years, it is still a matter of debate. There is a trend toward surgical intervention with the advent of newer surgical techniques. This study aims to evaluate the functional outcome of titanium elastic nail system (TENS) for the treatment of femoral diaphyseal fractures in this age group. Materials and Methods: This study included 63 children between 4 and 14 years of age who sustained femoral diaphyseal fractures and were managed by TENS nailing during the period of the study between April 2017 and April 2020. Results: All patients showed union; there were no cases of nonunion or delayed union or implant failure. Three patients had exposed implant, and 15 developed superficial infections which subsided with antibiotic treatment. Forty-eight patients had excellent Flynn score, and 15 had a satisfactory score. Conclusion: In our series of patients, we concluded that TENS nailing in the study group was easy and reliable. As it is a load-sharing device and does not violate the physis, it allows early mobilization and maintenance of alignment. Other notable advantages include decreased risk of infection and undisturbed fracture hematoma. Superficial infection was one of the commonly observed complications which subsided with oral antibiotics.

Management of diaphyseal long bone fractures in paediatric age group by tens

Background: Diaphyseal fractures in children are among the most common major paediatric injuries treated by orthopaedic surgeons and account for approximately 1.6% of all fractures seen in this population. Peak incidences occur at 2 & 17 years of age in bimodal distribution and boys have 2.6 times greater incidence than girls. The aim of this study is to evaluate the results of operative treatment of paediatric diaphyseal fractures in the age group between 5 to 12 years using titanium elastic nails (TENs). Material and Methods: This is a Prospective Study based on patients admitted with Diaphyseal Fractures in Long Bones in the age group of 5 years - 12 years in the Department of Orthopaedics, government general hospital attached to government medical college, Nizamabad, study was conducted between March 2016 to March 2017.Results: In the age group 5years to 8 years there were 14 (47%) and 9 years to 12 years there were 16 patients (56%). In our study the fracture was transverse in 15 cases (50%), short oblique in 7 cases (24%), spiral in 6 cases (20%), segmental in 1 (3%) and comminuted in 1 case (3%).

Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

<p class="abstract"><strong>Background:</strong> A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.</p><p class="abstract"><strong>Methods:</strong> We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year. </p><p class="abstract"><strong>Results:</strong> In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.</p>

Conservative vs. surgical intervention in diaphyseal forearm fractures in age group 1 to 15 years: A prospective study

Pediatric diaphyseal breaks of the radius and ulna, regularly alluded to as both bone lower arm fractures, are the third most basic fractures in the paediatric populace and record for 13-40% of all pediatric fractures.1, 2. More than 40% of young ladies and more than half of young men manage no less than one fracture amid youth and adolescence, (3) with distal lower arm breaks being among the most widely recognized, representing up to 33% of all pediatric fractures. (3) Thus, the role of a childhood distal forearm fracture, in particular, on fracture risk later in life, would have practical clinical applications. Given the magnificent rebuilding potential of youthful patients, certain examinations have concluded that even with 100% uprooting of the radius and ulna closed reduction is an amazing treatment decision for youngsters 9 years of age and younger [14, 15]. Nonetheless, the correct measure of angulation, dislodging, and revolution of bone stays questionable in the writing. It is by and large acknowledged that the nearer the fracture is to the distal physis, the more prominent the potential for rebuilding. Moderate management is yet the main line of treatment for pediatric lower arm fractures particularly in youngsters under 10 years of age. By and by if intervention is required whether adaptable nails or open reduction with plating is needed, then both plating and nailing are adequate treatment choices but however it is nailing which provides less invasiveness, Thus this study shows light upon the management choices available with their pros and cons for various forearm fractures.

A study on clinical, functional and radiological outcome of high velocity tibial plateau fractures managed by dual plating

BACKGROUND: Dual plating in comminuted bi-condylar tibial plateau fractures remains controversial. More methods of treatment have been described, each has got its own merits and demerits. We performed a prospective study to evaluate the Clinical , functional and Radiological outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a posteromedial approach. MATERIAL AND METHOD: We treated 21 high velocity tibial plateau fractures ( Schatzker type V and VI ) with lateral and medial plates through an anterolateral approach and a posteromedial approach over 2 years period . Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The outcome was evaluated according to the Honkonen Jarvinen criteria on follow up. RESULTS: The incidence of male was more compared to females in the ratio - 3.2 : 1. The nature of injury is high velocity injury as it is explained by all patient sustaining road traffic accident .None had sustained injury as a result of trivial trauma as occurs in elderly with osteoporotic bone.The incidence of fracture in right side was 42.9 % and in left side was 57.1 % which nearly equal.Among 21 cases, the incidence of fracture in age group 40 -50 was 52.4 %.Of 21 fractures , 7 patients ( 33.3 % ) had Type V fracture and 14 patients ( 66.7 %) had Type VI fracture.There were no associated injury in all patients .All patients underwent standard surgical procedure by anterolateral & posteromedial approach .Lateral locking plates were used for lateral plateau and T/L Buttress, Semi tubular, Recon plates were used for medial plateau.Bone Grafting was used for 9 patients ( 42.9%) to fill metaphy seal defect.Time required for union ranged from 11 to 16 weeks with average being 12.9 weeks. CONCLUSION: High velocity tibial plateau fracture have excellent to good clinical, functional and radiological outcome . Early mobilisation of the joint provides good range of motion . Posteromedial plating provides a buttress to posteromedial fragment and thereby prevents varus collapse.The patients with good soft tissue cover should undergo anatomical reduction and rigid fixation immediately without deferring time. This is a short term study and need follow up to predict the further outcome.

Functional and radiological outcome of intertrochanteric fracture in patients treated with dynamic hip screw and proximal femoral nail

Background: The aim of the study was to assess the functional and radiological outcome of intertrochanteric fracture in elderly patients treated with dynamic hip screw or proximal femoral nail. Materials and Methods: The study was conducted in Government Stanley hospital, from May 2014 to December 2015. A total of 98 cases of intertrochanteric fractures in age group of 55 to 65 years admitted were included in our study. Patients with pathological fracture was excluded. The 98 patients were divided into stable and unstable groups using Evans classification. DHS was done for 56 of them and PFN for another 42 of them and results were evaluated. The mean duration of surgery, mean blood loss and mean length of incision, intraoperative complications, time of weight bearing were evaluated. The Harris hip score was used to evaluate the hip joint function. Results: Most of the patients in our age group were between 55 to 65 years around 80%. The mean duration of surgery, mean blood loss and mean length of incision was more in DHS group then PFN group. We came across more intraoperative complications in PFN group then DHS group. Time of weight bearing was more in unstable fracture in DHS group. The Harris hip score was in favour of PFN at six weeks after surgery but it became same in both groups after 20 weeks of surgery. Conclusion: PFN has advantage of smaller incision, less blood loss and less morbidity. The short lever arm and lower bending moment in PFN may add mechanical advantage to the construct which makes it the implant of choice in osteoporotic bones. Deformity and complications was less in PFN group in our study. Rate of fracture union was similar in both groups with early mobilization in PFN group, DHS found to be the implant of choice for stable fracture but for unstable fracture PFN is the better choice.

Titanium Elastic Nailing in Pediatric Femoral Diaphyseal Fractures in 6-14 Years Age Groups.

Fractures of femur in pediatric age group is mainly age dependent .Treatment below 5 years mainly conservatively, by cast or traction plus casting due to good healing capacity and remodeling .Above 17years were skeletal maturity is achieved interlocking nailing is standard treatment. But in age groups 6-14 years treatment is controversial .There are number of treatment modalities likes casting, traction followed by casting external fixator, plating ,elastic nailing, ,inter locking nailing with entry portal other than pyriform fossa. Because in this age group remodeling capacity is less and displacing muscle forces are high, requiring accurate reduction and maintenance This is prospective study of 22 patients with single isolated femoral diaphyseal fractures in age group of 6- 14,With transverse, short oblique and minimal comminuted fractures are treated with titanium elastic nails. results are evaluated by radiological union, weight bearing , return to school, any complications ,patient satisfaction , and flynn's scoring criteria Titanium elastic nailing is a simple operative procedure which can be done by closed method minimal incision, with minimal blood loss, less complications and high patient satisfactory rate.

English

INTRODUCTION: Femoral shaft fractures are common fractures in paediatric age group. There are various methods to treat them. Elastic stable intramedullary nailing is one of them and an established and reliable method for treating these fractures. Ideal treatment of femoral shaft fractures in the age group of 5 to 14 years is still a matter of debate as no consensus has been achieved till now. We have done a study to know whether elastic stable intramedullary nails can be used reliably in this age group. So, purpose of the present study is to evaluate the outcome of titanium and stainless steel elastic nail in paediatric femoral fractures in 5-14 years of age group. METHODS: A group of forty two children with femoral fractures that were treated with elastic nails (which includes both titanium and stainless steel nails- both nail types were of similar design) and outcome was evaluated. Twenty children (16 boys, four girls) in the age group of 5-14 years (average 9.3 years) with femoral shaft fractures (16 closed, two Grade- I and two Grade- II compound) were stabilized with Titanium Elastic Nail (TEN), while twenty-two (16 boys, six girls) in the age group of 5-14 years (average 9.1 years) with femoral shaft fractures (18 closed, two Grade- I and two Grade- II compound) were stabilized with Stainless Steel Elastic Nail (SSEN) between June 2009 and October 2011. A familiar retrograde insertion technique was used. Major complications were defined as malunion with sagittal angulation of >15° and coronal angulation of >10°, nail irritation requiring revision surgery, infection, delayed union, and rod breakage. Minor complications were defined as nail irritation or superficial infection not requiring surgery. RESULTS: Radiological union was achieved in all cases in a mean time of 7.7 weeks (6-12 weeks) in TEN groups while that took 7.9 weeks in SSEN group. Full weight bearing was possible in a mean time of 7.7 weeks (6-12 weeks) in TEN groups and a mean of 7.9 weeks in SSEN group. All cases were assessed by Flynn classification method and outcome scoring system. We noted excellent results in 26 cases (63%), satisfactory results in 14 cases (33%), while poor result in 2 cases (4%) in this study. There were six minor complications such as one superficial cellulitis and one case of implant-related pain and four cases of skin irritation at the nail tip (18%). Two cases deep infection (both cases are associated with grade II open fractures) requiring prolonged treatment with antibiotic were seen in each group. 2 case of shortening >1cm (9%) but 100 (9%) was seen with stain less steel elastic nail. CONCLUSIONS: Our results indicate that that elastic nail can be effectively used to treat fractures of diaphysis of femur in children. It can also be used very effectively in open fractures (up to Gustilo &Anderson grade II), in comminuted fractures (up to Winquist & Hansen type II) and in a multisystem injured patient.

Pediatric Femoral Shaft Fracture Management By Titanium Elastic Nailing; A Prospective Study Of 112 Patients

Objective – To assess the usefulness of TENS in treatment of pediatric femoral shaft fractures, which is one of most common pediatric major injuries encountered to orthopedic surgeon.Material and method – The study was conducted on 112 patients admitted at Govt. Medical College, Haldwani in the Department of Orthopedics from January 2007 to Januray 2012. We included patients of age group of 5 -15 years with fracture shafts of femurs excluding grade 3 compound fractures and pathological fractures. Patients were followed more than a year. Greater emphasis was given on complication analysis, major complications like limb length discrepancy, infection, angulations, and loss of knee movement were noted. Functional outcomes were analyzed according to Flynn criteria. In our prospective study by using Flynn criteria, 86 had excellent results, 24 had satisfactory results, and 2 had poor results.Discussion and conclusionTreatment of long bone fracture in pediatric age group by titanium elastic nail is broadly under acceptance. Technical ease, good functional outcome, preservation of epiphysis, low complications are very favorable point for TENS use for femoral shaft fracture. Encouraging reports and low complication from our study also supports exclusive use of TENS in pediatric femoral shaft fracture in age group 5-15 years.

A clinical study of Ender nails fixation in femoral shaft fractures in children

Background : Fracture of femoral shaft is fairly common in children and should be considered serious because of blood loss and potential shock that accompany the primary trauma. Surgical procedure allows early mobilization, rapid callus formation and rapid restoration of continuity of bone. Method : We studied 24 children with 24 femoral shaft fractures in age group 6-14 year (average 9.67 years). Eighteen fractures were in middle third, 4 in distal third and 2 in proximal third. Fifteen fractures were transverse, 4 oblique and 5 were spiral. Twenty-three cases were closed and one grade I compound. The injury surgery interval was 6 day. Mean hospital stay was 10.4 days. They were treated by closed reduction and Ender's nail fixation. Result : The minimum follow up was 6 months. The average time to clinical union and full weight bearing was 6.6 week (5 to 12 week); full movement was achieved in 9 weeks (6 to 15 weeks). One case of intraoperative perforation occurred. Two cases of nail protrusion and infection occurred. No cases of deep infection, delayed union, nonunion were seen. Seven cases had no limb length discrepancy. Thirteen cases had lengthening (max 9 mm mean 4.23mm), 4 cases had shorting (max 7mm mean 4.25mm). On the Flynn criteria 20 denoted excellent and 4 had satisfactory results. No poor results were seen. Conclusion : Healing in cases treated with Ender's nail can be with abundant callus attributed to non rigid fixation. This resulted in rapid fracture union and early return to few weight bearing while reducing hospital stay. Advantages that Ender nailing offers over other treatment modalities both consecutive as well as operative convinces us to recommend ender nailing in isolated femoral shaft fracture in children between 6-14 years.

Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures

There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender's nails fixation of femoral shaft fractures in children. We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender's nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique. The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups. Though operative time is more and healing is delayed in Ender's nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender's nail fixation of femoral shaft fractures in children.