Long Bone Fractures In Children Research Articles

Management of closed diaphyseal fractures in children in two black African countries: Preliminary results and epidemiological profile

Objectives: The objective of this study was to describe the clinical evolution and the epidemiological profile of long bone fractures in children in two African countries. Methods: This was a five-year retrospective study of closed fractures of long bones in children aged 9.7 years (Ranging 4–16). Seventy-two fractures were treated by elastic stable intramedullary nailing and plate osteosynthesis. The results were evaluated according to Oestern and Tscherne criteria, and parental satisfaction was assessed using an individual investigation form. Results: The treatment of closed fractures of long bones in children is marked by complications such as infection (16.6%), implant migration (19.4%), non-union (11.1%), and malunion (2.7%). According to the assessment criteria, 33.3% were excellent, 45.8% were good, and 20.8% were poor. Twenty percentages of parents were very satisfied, 61% were satisfied, and 18% were disappointed with the outcome. Conclusion: Osteosynthesis is only indicated in common pediatric trauma if the capabilities of remodeling a callous are insufficient. It should not be the first choice in children’s fracture therapeutic options.

Outcome of Flexible Intramedullary Nailing versus Plating in Treatment of Diaphyseal Femur Fractures in Paediatrics: Systematic Review and Meta-analysis

Abstract Background Pediatric femoral fractures are the most the common long bone fracture in children, with one third of these occurring between ages 5 to 12. These injuries are usually the result of road traffic accidents, sports and non-accidental injury. Different modalities exist for managing these fractures, often stratified according to the age of the patient. Aim of the Work The aim of this work is to provide a complete overview of the optimal surgical treatment of diaphyseal femur fractures in children by evaluating and comparing the clinical and functional outcomes of flexible intramedullary nailing versus plating for such fractures. Patients and Methods This review followed the Cochrane Handbook's standard methodology and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- analyses (PRISMA) statement guidelines. Result In patients undergoing flexible nailing, the surgical variable data found this treatment modality to be superior in terms of certain operative features: shorter operative duration times (p = 0.00001), smaller volumes of estimated blood loss (p = 0.00001). There was no difference regarding length of hostital stay (p = 0.59). This suggests that flexible nailing may offer increased safety to patients in terms of duration of anesthesia, volume of blood loss, and cost of surgery when compared to plating. However, Secondary outcome analysis also found a statistically significant increased risk of malunion (p = 0.002) and metalwork irritation (p = 0.00001) when using FIN compared to plating techniques. There was no difference regarding risk of infection (p = 0.53) and developing leg length discrepancy (p = 0.44). Conclusion Options for stabilization and fixation in this age group include flexible nailing, plating (open or sub-muscular), external fixation, or hybrid techniques.

Functional outcomes of femoral diaphyseal fractures using titanium elastic nail: A retrospective study

Background: Femoral Diaphyseal is common fracture in pediatrics. The Titanium Elastic Nail is designed to stabilized the long bone fracture in children where the implant flexibility is paramount and medullary canal is narrow. This study evaluates the functional outcome and complications of using elastic nail. Materials and Methods: This was a single centric, retrospective and clinical investigation study. The study was consisting of thirty-eight children (29 boys, 9 girls) aged group of 9-15 years who underwent femoral diaphyseal fracture treatment in Gautemala between March 2018 to June 2019 were recruited. The patient outcome was analyzed by physical examination, radiographs, VAS and ASA score by one year follow up. Results: The result showed better outcomes in all the patients with decline in the VAS score. All patients were available for the follow up of one year. The bone union was achieved in mean time of 7.1 weeks. The study reveal that no mechanical failure related to nail, bend or corrosion was seen in the patients. Finally, all the patient’s bone healed with time without any adverse effect and severe complications. Conclusion: The elastic nailing fixation is an efficient method for treating long bone fracture in children’s.

Treatment of pediatric tibial shaft nonunion using ipsilateral free non-vascularized fibular graft.

Although tibial shaft fractures are the third most common long bone fractures in children after the forearm and femur, nonunion of these fractures are rare in the pediatric population. Despite seldom seen, tibial nonunion is very complex and it is also a devastating complication of tibial fracture especially when infected. Numerous methods have been employed to treat pediatric tibial nonunion, but there is no consensus. Here, we present a case of a child with right tibial shaft fracture nonunion. We treated this patient with ipsilateral free non-vascularized fibular graft. Both the nonunion site and fibular donor site united well with good function in the injured extremity and no adverse events. We recommend the use of ipsilateral free non-vascularized fibular graft for the treatment of pediatric tibial shaft nonunion.

Evaluation of overgrowth in pediatric radius fractures

PurposeForearm fractures are the most frequent long bone fractures in children. There have been many reports of differences in leg length due to overgrowth in lower extremity fractures. However, reports of such overgrowth in fractures of the upper extremity are rare. The purpose of this study was to investigate the relationship between angulation and overgrowth in pediatric radius fractures. We hypothesized that more angular deformation of the fracture would result in a periosteal transection and more overgrowth. MethodsRetrospectively, between 2013 and 2022, 14 patients under 16 years of age (mean age 9.43 years; 10 boys, four girls) with unilateral radius shaft or metaphyseal fracture without physeal injury, and a minimum follow-up of 12 months, were included. Demographic factors were analyzed; age, sex, body mass index (BMI), right or left. We evaluated the radiologic parameters; ulnar variances, degree of angularity before intervention, fracture gap and treatment options. The patients underwent conservative or surgical treatment. ResultsThe mean follow-up period was 27.9 months (range, 13–53 months). Eight patients underwent cast treatment, and six patients underwent surgical treatment. The difference in ulnar variances between the unaffected side and fracture side were statistically significant (P < 0.001). Sex, age, left or right, height, weight, and BMI were not statistically significant. The surgical treatment group (P = 0.013) and the sum of the maximum angularity (P = 0.017) were statistically significant. When the sum of the maximum angularity(SMA) was 30° or more, the ulnar variances were statistically significant, compared with the case where the SMA was less than 30°. The clinical results evaluated at the last outpatient follow-up were good in all patients. ConclusionsFirst, this study implies that the degree of angulation of the fracture may affect the overgrowth of the radius in case of radius shaft or metaphyseal fracture, without physeal injury. Second, it implies that the degree of overgrowth may increase with surgical treatment, as opposed to that with conservative treatment. Level of evidenceLevel IV, Retrospective study

Treatment of long bone fractures in children by elastic stable intramedullary nailing: Outcome and challenges in a unit with restricted technical platform.

Elastic stable intramedullary nailing (ESIN), developed by the Nancy school in France, is the gold standard for surgical treatment of long bone fractures in children. In Africa, few works have been devoted specifically to this technique. This study aimed to describe the outcome and to present the challenges with this technique in the treatment of long bone fractures in children. This was a prospective and descriptive study over 4 years including patients aged 0-15 years old operated using ESIN. Sixty-two patients underwent ESIN, of whom 44 patients (70.96%) were for femur fractures, nine patients (14.52%) for tibia and fibula fractures and nine patients (14.52%) for humerus fractures. The majority of the patients treated with ESIN were children older than 6 years. Nine patients (14.51%) and 13 patients (20.98%) underwent ESIN following polytrauma and multiple fractures, respectively. Seven patients (11.29%) were operated on through-closed ESIN method. The unavailability of image intensifier (38.71%) and the presence of bone callus (40.32%) were the major reasons for using the open ESIN method. Thirty-three patients (53.23%) had minor or major complications. The majority of patients had satisfactory therapeutic outcomes. ESIN gives good results, even when the fracture site is approached.

Treatment preferences of orthopedic surgeons for closed, isolated middle-third diaphyseal long bone fractures without neurovascular injury in children: A cross- sectional survey.

This study aimed to assess the treatment trends and the factors influencing the treatment methods of Orthopaedic Surgeons in closed, isolated, middle-third diaphyseal long bone fractures without any neurovascular injury in children. This was a cross-sectional electronic survey of Turkish Orthopaedic Surgeons who were active members of the Turkish Society of Children's Orthopaedics (TSCO) and still managing the children's fractures in their daily clinical practice. An initial e-mail including the electronic survey followed by three reminder e-mails was sent to 110 members, and then reminder telephone calls were made. The survey response rate was 66/110 (60%). In recent years, a definitive trend to surgical treatment was not seen 98%, 77%, 39%, and 88% of the responders in the closed humerus, forearm, femur, and tibia mid-shaft fractures, respectively. Neither the years of expertise nor the intensity of daily pediatric patients of the participants did not affect the treatment trend in any fracture scenarios. The patient's age was the most cited factor influencing the responders' decisions on whether conservative or surgical treatment would be performed in each fracture scenario. The most cited lowest age limits for surgical treatment inclosed mid-shaft fractures of the humerus, forearm, femur, and tibia, were the adolescent age group, 10-12 years, six years, and ten years, respectively. This is the first study assessing the daily clinical practice of members of TSCO in the management of closed, isolated, non- complicated middle-third diaphyseal long bone fractures in children just before the covid-19 pandemic started. A marked tendency toward surgical treatment is seen in femur mid-shaft fractures, followed by forearm mid-shaft fractures up to a certain level. The patient's age is the main determinant of the responders' decisions on the type of treatment in closed, isolated, non-complicated middle-third diaphyseal long bone fractures in children.

Pediatric Tibial Shaft Fractures Remodeling After Casting

Background and The tibial shaft fracture is the most common long bone fracture in children. This type of fracture has a high capacity for deformity correction, a process known as remodeling. In many circumstances, casting is the choice of treatment. Objectives: This study aims to investigate the rate of tibial fracture remodeling after 6 months of non-rigid fixation. Methods: This research was a retrospective study conducted from March 2017 to March 2018. The study population included 74 children with tibial shaft fracture, treated with a long leg plaster under general anesthesia. Patients were evaluated by obtaining anteroposterior (AP) and lateral view x-rays in the first week, second week, 2 months, and 6 months after casting. Results: Seventy-four individuals were admitted with a diagnosis of tibial shaft fracture. A total number of 39 patients (52%)-13 girls and 26 boys- were treated with the long-leg casting under general anesthesia. The patients’ average age was 7.94±2.69 years (2-14 years). In the second week, four cases were excluded. Remodeling in the fracture site was significant in AP radiography at the end of the second month (P=0.044). Six-month follow-up showed that the remodeling in AP was significant (P=0.017) while in lateral was partially significant (P=0.05). Conclusion: Due to the presence of the growth plate and a dense periosteum, remodeling of the tibial shaft fracture is extremely likely, and the remaining deformity is corrected over time by casting, and no surgical intervention is required. Level of evidence: IV

Pediatric long bone fractures treated by elastic intramedullary nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pediatric long bone fractures can have a high morbidity and long term disability among the survivors. The present study was aimed to study the clinical outcomes of children with long bone fractures managed by elastic intramedullary nail.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We retrospectively reviewed the medical records of children (aged 2 to 15 years) who were admitted and treated for unilateral femoral, tibial or forearm fractures with elastic intramedullary nail from January 2018 till February 2020. All were managed with elastic intramedullary nailing. The union times and complications were noted from the medical records.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Femoral, tibial and forearm bones were involved in 15 patients each (33.3%). Road traffic accident was reported by 31%) and physical abuse by one case (2%). The mean time of union was 10 weeks, ranging from 6 to 12 weeks. The mean time for union of the femur and tibia was 11.54 and 11.34 weeks respectively. It was significantly lower for forearm (6.67 weeks, p value &amp;lt;0.05). Two patients reported of bursitis and impingement, which were resolved after nail removal. One case had limb length discrepancy of about 0.5 cm in femur fracture, which was not impairing functional activity. Functional status was assessed based on Flynn criteria was found to be excellent in 36%, good in 44% and fair in 20%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of the present study show that titanium elastic nail (TEN) is an effective treatment modality for managing pediatric long bone fractures. We recommend the use of TEN in managing long bone fractures in children.&lt;/p&gt;

Titanium Elastic Nails for Distal Radius-ulna Fractures in Young Dogs

Background: Radius-ulna is the most frequently fractured bone of the pectoral limb in dogs with high predisposition to distal fractures. The smaller size of the distal fragment and open physis restrict the use of rigid fracture fixation techniques in distal fractures of growing dogs. Titanium elastic nails (TENs) are recommended in medical practice to stabilize long bone fractures in children. There is paucity of literature on TENs for the repair of radius-ulna fractures in dogs. Methods: This clinical study enrolled 10 dogs (7 grey hound and one each of Crossbred, Pomerenarian and Siberian Husky) suffering from distal radius-ulna (6 transverse and 4 short oblique) fractures since a mean ± SD duration of 3.40±4.5 days. The mean ± SD age and body weight of the dogs was 12.60±6.45 months and 14.09±6.41 Kg, respectively. All except one fracture was stabilized with two TENs inserted into the medullary canal of radial bone in a normograde manner from distal to proximal end using open cranio-lateral surgical approach. Result: Majority fractures achieved satisfactory reduction (n=8), radiographically. Weight bearing scores on walking increased gradually from day 12 (1.62 ± 1.51) to 45th (2.57±1.51), day 60th (3.75±0.5) and day 90 (4.0±0). Five dogs had uneventful recovery whereas remaining had major (n=2) or minor (n=3) complications. The length of the operated bone was non-significantly lesser as compared to contralateral healthy bone on day 60. Goniometric assessment of carpal joint of operated limb showed restricted range of motion on day 12 that improved to the near normal as contralateral healthy limb on day 60. Long-term results showed full (9) and acceptable (1) functional outcome. In conclusions, the TENs technique is simple and less invasive alternative fixation technique for distal radius-ulna fractures in young and light weighing dogs. As per authors, this is the first report on the use of TENs for the management of radius-ulna fracture in dogs.

Traumatic long bone fractures in children seen in a metropolitan tertiary hospital in Enugu, Nigeria

Injuries in children are a well-known occurrence and often lead to fractures. The fractures may affect long bones, occur in all ages and could be accidental or non-accidental with associated injuries that may cause disability or permanent deformity. Lack of epidemiological research on causes, mechanism of injury and site of long bone fractures in children in our environment prompted this study. The study evaluates variables that maybe responsible for long bone fractures in children and document them accordingly for use in planning injury prevention strategies in children. The study was carried out in a tertiary hospital in a metropolitan city (Enugu State University of Science and Technology [ESUT] Teaching Hospital, Enugu, Nigeria). Medical records of patients, ward admission register, accident and emergency register and theatre registers were used for data collection. Children under 16 years who presented to the hospital with long bone fractures between January 2015 and December 2017 were part of the study. Eighty-five children with 86 long bone fractures out of 258 children that presented and were admitted into the orthopedic service were noted. Mean age of patients was 7.2 years + 1.8 years. The commonest long bone fractured was the femur n- 23 (26.7%). Males-female ratio was 1.15:1. Fall from height was the commonest cause of injury and abrasion/laceration the commonest associated injuries. Long bone fractures in children occur mostly due to falls from height and affects the femur more than any other bone. Bimodal annual occurrence rate has been noted and caregivers ought to be more vigilant during those times to help reduce the rate of long bone fractures in children.

Use of flexible nails in children diaphyseal fractures. Five questions and answers

Introduction More than 40 years after the launch of elastic stable intramedullary nailing (ESIN) as a golden standard of the treatment of some fractures in children and adolescents. Material and methods This review is based on answers to five essential questions: The position of ESIN compared with other methods of treatment; The choice of the implants; The indications for ESIN today; How to avoid complications as much as possible? Do we remove the implants or not? Results The aspects of biomechanics, design, indications for ESIN in comparison to other treatment, surgical techniques depending on fractured bones, complications are presented in the article. Conclusion ESIN is an excellent method to fix long bone fractures in children and adolescents. Top one is definitively the fractures of both bones of the forearm, then the diaphyseal fractures of the femur and the tibia before the age to be eligible for a locking nail. However, some unstable fractures cannot be treated conservatively or with a locking nail, and an ESIN remains unstable. In these cases, we are allowed to propose to add an external fixator for 4 to 6 weeks, waiting for a good stabilisation of the fracture.

Clinical Efficacy of Minimally Invasive Elastic Stable Intramedullary Nailing for Limb Long Bone Fractures in Children.

ObjectiveThe aim of the present paper was to investigate the clinical efficacy of minimally invasive elastic stable intramedullary nailing (ESIN) for long bone fractures in children.MethodsA total of 350 children with limb fractures from June 2012 to June 2018 were recruited and randomized into two groups: an ESIN group (n = 175) treated with elastic stable intramedullary nailing, and an MPIF group (n = 175), treated with metal plate internal fixation. Both groups received the same physical examination and routine medication. Operation related indexes, clinical efficacy, complications, and postoperative quality of life scores were analyzed and compared.ResultsThe operation time, intraoperative blood loss, hospitalization time, and fracture healing time in the ESIN group were 43.74 ± 4.96 min, 8.14 ± 1.34 mL, 5.97 ± 1.88 days, and 55.89 ± 5.61 days, respectively, which were all significantly less than those in the MPIF group (all P < 0.001). In terms of common complications after limb fracture treatment, there were 6 cases of osteomyelitis, 5 cases of skin irritation response, and 7 cases of inflammatory granuloma in the MPIF group. There were 2 cases of skin irritation response and 5 cases of inflammatory granuloma in the ESIN group. The incidence of postoperative complications in the ESIN group was 4.00%, which was significantly lower than that in MPIF group (10.29%) (P < 0.05). The effective rate for recovery condition in the ESIN group (93.71%) was significantly higher than that in the MPIF group (P < 0.001). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (79.43%) (P < 0.001). The postoperative satisfaction rate in the ESIN group (94.29%) was significantly higher than that in the MPIF group (86.29%) (P < 0.05). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (P < 0.001). The postoperative satisfaction rate and the acceptance rate for adjacent joint function in the ESIN group (100%) were significantly higher than those in the MPIF group (92.00%) (P < 0.0001).ConclusionElastic stable intramedullary nailing is a minimally invasive procedure for long bone fractures in children. It can effectively improve the operation‐related indicators and postoperative quality of life and reduce the incidence of complications.

Functional outcome of tibial fractures in children treated by supracutaneous locking plates

Background: Tibial shaft fractures are third most common type of long bone fractures in children after femur and forearm.Aim: The purpose of the study is to evaluate the functional and radio logical outcome results of Closed reduction or open reduction of tibial fractures and fixation using locking plate as supra cutaneous external fixator in children.Methods: In this observational study 32 children with tibial fractures having soft tissue injury underwent external fixation with locking plates. There were 22 male and 10 female children with mean age of 10.59years (range 6 to 15 years) who sustained fracture in RTA. 84.4% cases had closed fractures, and 15.6% cases had open fractures. Out of the cases with open fractures, 60% had grade 1 injury, and 20% each had grade 2 and grade 3b injury respectively. Results: 7, 9, 11, 13 Holed LCP were used in 34.4%, 25%, 25% and 15.6% patients respectively. Screw tract infections were observed in two patients who had serious discharge and was relieved with oral antibiotics. No deep infections were reported. All the fractures united by the end of 24 weeks after bone grafting. In all most all the patients skin condition was found to be good in follow up.Conclusion: The present study though in small number (32) shows that use of LCP plate as supra cutaneous external fixator is an effective method in terms of stability of fixation, utilisation as permanent fixation method and less complication rate.

Assessing the Necessity for the "Joint Above and Below" Radiography Approach for Lower-extremity Long Bone Fractures in Children.

A common strategy for evaluation of extremity fractures is the "joint above and below" (JAB) radiograph approach, which includes dedicated imaging of the joint proximal and distal to a fracture independent of clinical suspicion for an injury involving the joint. The incidence of concomitant ipsilateral lower-extremity fractures or dislocations associated with lower-extremity long bone fractures in children has not been commonly reported and represents an evidential gap for determining a radiograph approach. Our purpose was to determine the frequency of and risk factors for concomitant ipsilateral lower-extremity fractures or dislocations. A retrospective study of children aged 1 to 17 years treated at an academic medical center emergency department from 2015 to 2018 with any fracture involving the tibia, fibula, or femur. Children with pathologic fractures, transferred from another facility, and/or designated as a level I trauma were excluded. The primary outcome was the prevalence of a concomitant bony injury (fracture or dislocation) at a distinct site in the same extremity. Differences between the concomitant bony injury group and single injury group were characterized using Fisher exact tests. Regression analysis was used to determine predictors of concomitant bony injuries, including age, sex, and mechanism of injury (with injuries requiring level II or III trauma activation classified as high risk). During the study period, 241 patients with lower-extremity long bone fractures were included. Complete JAB radiographs, defined as dedicated orthogonal radiographs of the joint proximal to and distal to the fracture site, were taken in 85 (35.3%) of 241 patients. Concomitant bony injuries were found in 9 (3.73%) of 241 patients (95% confidence interval, 1.7-7.0%). No additional concomitant bony injuries were identified at follow-up. When comparing patients with and without concomitant bony injuries, there was no significant difference in age (P = 0.34) and sex (P = 0.73). However, patients with a high-risk injury were more likely to have a concomitant bony injury (P < 0.01; odds ratio, 21.9; 95% confidence interval, 3.6-131.5). Concomitant ipsilateral lower-extremity fractures or dislocations are uncommon in children sustaining tibia, fibula, and/or femur fractures. Although the JAB approach to radiographs may be useful in identifying additional injuries in children with lower-extremity injuries resulting from a "high-risk" mechanisms, its overall yield is low. To provide safe, cost-effective care, providers should continue to value clinical suspicion, history, and physical examination findings to guide selection of radiographs in those with lower-extremity long bone fractures as significant fractures can typically be identified with limited imaging in patients with low-risk injury mechanisms.

216 Defining Quality in the Emergency Department Care of Long Bone Fractures in Children: Identifying Parents and Youth’s Priorities

216 Defining Quality in the Emergency Department Care of Long Bone Fractures in Children: Identifying Parents and Youth’s Priorities

85 Parent and youth experiences of emergency department care for suspected long bone fractures in children

Abstract Background Long bone fractures are a frequent reason for visits to the pediatric emergency department (ED) where patients obtain the definitive care they require. Youth are rarely involved in quality assessment and improvement initiatives. Objectives To describe parent and youth experiences of their ED care for suspected long bone fractures. Design/Methods This prospective survey study of parents/youth consulting a tertiary care pediatric ED used surveys co-constructed by ED clinicians and parent partners. English/French speaking patients aged 10 to 18 years old with suspected long-bone fracture at triage – and their parents – were eligible to complete the survey during their ED stay. Electronic surveys were developed for parents and youth and pre-tested with 12 youth and 14 parents. Descriptive data was generated using SPSS v.25 (IBM Inc.). Results Three hundred surveys were distributed to eligible participants from March 2018 to June 2019 and 249 surveys were completed (148 parents, 101 youth). At least one member from 189 families completed a survey. Parents and youth participants had median ages of 44 and 12 years old, respectively. Most patients (98%) had a radiograph as part of their work-up, usually in the ED (76%); Twenty-seven percent were referred with radiographs. Most families (61%) received a diagnosis of long-bone fracture and were referred to orthopaedics for outpatient follow-up. Families’ median length of stay was 4h08min (range 43 min-14h30min). Parents (88mm) and youth (81mm) reported high median satisfaction with their overall ED care on 100 mm visual analog scales. Most parents (81%) and youth (75%) reported receiving just enough information from ED staff, though only half (50%) of the parents received information on how to care for their child at home. More than 90% of parents believed that the ED team treated their child’s pain. Eighty-one percent of youth reported that pain was treated sufficiently although 63% believed it had been treated quickly. Most parents (56%) and youth (72%) reported their ED stay was longer than anticipated; parents’ perceptions did not correlate with ED length of stay on logistic regression (p=0.014), while youth’s did (p=0.009). Few parents (33%) or youth (32%) reported receiving regular information on ED wait times. Conclusion Parent and youth perspectives of their ED care are complementary, and both should be considered in patient-oriented quality improvement initiatives.

A Novel Technique for the Removal of Elastic Intramedullary Nail in Pediatric Long Bones: A Technical Note.

Elastic stable intramedullary nails have been commonly used to treat unstable long bone fractures in children. The nail tip at the insertion site can cause problems. The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems. If the nail tip is short, nail removal after fracture union can be difficult and may pose challenges. A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail. Few techniques have been suggested in the past for removing elastic nail with the short tip, but all these techniques need special instruments. We describe a surgical technique using a metallic suction cannula to aid elastic nail removal. This method utilizes an easily available instrument in the operating room and does not need any special equipment.

Limitations in Use of Elastic Stable Intramedullary Nailing (ESIN) in Children with Disorders of Bone Mineralization.

Elastic intramedullary nails (ESIN) have been the treatment of choice in many long bone fractures in children for more than 20 years. The introduction of ESIN has drastically reduced tissue traumatization during fracture fixation procedures and decreased the risk of growth cartilage damage, as well as allowing for preservation of the natural biology of closed fracture healing. The objective of the present report is to draw attention to a small group of patients with bone mineralization disorders, who consequently demonstrate decreased mechanical resistance of the skeletal system, in whom indications for using ESIN fixation are limited. The study group consisted of 6 patients who met the criteria for using ESIN fixation, but did not demonstrate a satisfactory outcome. The inclusion criteria included age below 18 years, appropriate ESIN nail insertion technique with correct calculation of nail diameter (2/5 of the medullary canal diameter), body mass &lt; 50 kg and achieving appropriate prebending that is the prerequisite of three-point intramedullary support. The patients' medical records and radiographs were analyzed and they were invited for clinical and radiological follow-up examinations. All six patients demonstrated a gradually increasing bending deformity of the long bone axis. Additionally, in three patients, there was intrusion of terminal parts of the nails into the bone. In one patient with bone fibrous dysplasia, the proximal epiphysis was perforated by the flattened ends of the nails. In all patients, the removal of the ESIN fixation was followed by single or double-level corrective osteotomies and Rush pin fixation. In cases of long bone fractures in children with metabolic bone disorders in whom the bone structure is weakened and the bones themselves are easily deformed, more rigid intramedullary fixation with Rush or Fassier-Duval type nails as primary osteosynthesis should be considered.

Paediatric Long Bone Fractures Managed with Elastic Intramedullary Nails: A Retrospective Study of 30 Patients.

Elastic intramedullary nailing or titanium elastic nail (TEN) is an alternative method for the treatment of various pediatric long bone fractures. Titanium nails are preferred over plaster cast and stainless steel nails for children older than six years. Our series included 30 paediatric long bone fractures who were managed with TEN. The mean age was 9.3 years and the mean follow-up period was 28 months. A mean time of 10 weeks was recorded for the union of all fractures. The occurrence of superficial infection in three cases healed with antibiotics and minor debridement. Limb length discrepancy was seen in three cases of femur fracture, which was functionally insignificant, but it may be a potential problem needing close follow-up until skeletal maturity is attained. An elastic intramedullary nail or TEN in long bone fractures in children is a safe and minimally invasive technique that achieves stable reduction, especially in long spiral fractures till union. We attained successful union and good results in all our 30 cases with long bone fractures in children. A few complications of hardware prominence were resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required.