Rush Nail Research Articles

The Outcomes of Intra-Medullary Square Nail for Adult Both Bone Forearm Shaft Fractures

Background: Forearm shaft fractures are common in developing countries. Anatomical reduction of these fractures using plates and screws is considered an accepted treatment mode. Like other shaft fractures, this can be treated with intramedullary nails like square nails, Rush nails, and interlocking nails. This study evaluates radiological and functional treatment results using square nailing.
 Methods: A prospective study was conducted on 100 adult patients with diaphyseal forearm fractures over 3 years. Out of 100 patients, 68 were men, and 32 were women. Patients were followed up at 2 weeks, 6 weeks, 8 weeks, and then every 3 months till 1 to 1.5 years. We have used criteria described by Anderson et al. and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score for functional evaluation of the patients.
 Results: Out of 100 patients, the union was achieved in 88 patients, while the rest 12 patients required re-surgery. 4 patients had delayed union, 4 patients developed an infection at the ulnar entry site, and 3 patients developed bursitis of olecranon bursa.
 Conclusion: Intramedullary nailing of both bone forearm shaft fractures using square nails can give satisfactory results in most cases, comparable with treatment by plates and screws, and provides an alternative, cost-effective treatment of both bone forearm shafts fractures with good cosmesis owing to small incisions.

A PROSPECTIVE STUDY ON THE ROLE OF INTRAMEDULLARY NAILING IN ADULT DIAPHYSEAL FOREARM FRACTURES, DURING COVID-19 PANDEMIC, HYDERABAD, INDIA

Background & objectives: Fractures of forearm bones may result in severe loss of function unless adequately treated. Intramedullary nailing is less traumatic than plate-and-screw xation along with preservation of fracture hematoma. Idea of primary bone healing was one of the reasons why intramedullary nailing became disregarded in favour of plate and screw xation. The COVID-19 pandemic caused surgeons, to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. This study aims to analyse functional outcome and advantages of intramedullary nailing (Titanium ElasticNails, Square or Rush nails) in treatment of adult diaphyseal forearm fractures during the pandemic. Methods: A prospective study on 16 cases of closed simple diaphyseal forearm fractures in the age group of 20 to 60 years from April 2020 to Jan 2021 managed with intramedullary nailing. Results were evaluated based on mode of anaesthesia, operating time, blood loss, average union time, modied Grace and Eversmann scoring system for functional outcome. Interpretation and Conclusion: Most cases received brachial block with mean operating time of 40 minutes. Blood loss was minimal. The average union time (radiologic evidence of callus) was 7 weeks. Functional outcomes were excellent in 12 patients (75%), good in 3 patients (18.75%) and poor in 1 case. Intramedullary nailing is a reliable but less invasive alternative for adult diaphyseal forearm fractures during pandemics with excellent stability and predictable results.

Are Rush Nails Still a Good Choice for Fibula Fixation in Ankle Fractures? A Retrospective Study with Five Years Follow-Up.

The aim of this retrospective study is to evaluate if Rush nail fixation still has a role in distal fibular fractures surgery compared with locking plate in terms of fixation quality, complications, functional results and patient satisfaction level. This study included 109 patients (average age 56.05), who had undergone operative treatment for bi- or trimalleolar fractures between 2009 and 2014. The patients were evaluated retrospectively, divided in group A (57 patients treated with Rush nail) and group B (52 patients treated with locking plate). The patients were evaluated at an average 4.9 years of follow-up (SD: 1.01) with Olerud-Molander Ankle Score (OMAS), American Orthopedic Foot and Ankle Society - Ankle-Hindfoot Scale (AOFAS) and Visual Analogue Scale (VAS) for clinical outcomes. X-rays were conducted to assess ankle osteoarthritis using the classification system by Takakura and joint space symmetry using measurements in comparison with contralateral ankles. The groups were homogeneous regarding age and gender. Patients treated with Rush Nail fixation (Group A) showed statistically significant worse clinical results at functional scores (78.1 Group A versus 88.7 Group B at the OMAS (P<0.05); 83.1 Group A versus 90.1 Group B at the AOFAS (P<0.05); higher pain levels in the VAS (3.9 Group A versus 2.4 Group B) and lower satisfaction rates (52.6% Group A versus 73.1% Group B (P<0.05)) in comparison with patients treated with locking plate fixation (Group B). However, infections rate was significantly lower in Group A (1.8%) than in Group B (9.6%) (P<0.05). Radiographic evaluation showed more cases of post-traumatic osteoarthritis in Group A (35.1% Group A versus 15.4% Group B (P<0.05)) and worse results in regards to restoration of joint space symmetry (45.6% Group A versus 73.1% Group B (P<0.05)). Results of current study indicates that even though plating of lateral malleolus in bimalleolar and trimalleolar fractures is superior in fracture reduction quality, early functional recovery, reduced incidence of post-traumatic osteoarthritis and greater patient satisfaction, Rush nail fixation still provides acceptable clinical results with a lower infection rate. Therefore Rush nails could be considered as a valid choice in selected patients with high risk of soft tissue complications or low functional demand.

Six Examples with Different Means of Operative Treatment of Humeral Shaft Fracture

We showed different cases and operative treatment of traumatic fractures of humeral shaft including operative treatment by means of external fixation, intramedullary fixation with long humeral nailing, intramedullary fixation with Rush nail and plate osteosynthesis. The indications were chosen according to fracture anatomy and biology but foremost by specific socioeconomic comorbidities and aspects of the patient itself. Bone healing status, postoperative local status, neurocirculatory status, postoperative physical therapy course and overall functional results of injured limb and patient satisfaction.

COMPARISION OF CLINICAL AND FUNCTIONAL OUTCOME IN MONTEGGIA FRACTURE: MANAGED WITH RUSH NAIL COMPARED WITH MANAGED BY PLATTING

Introduction- Monteggia is a fracture of the proximal third of the ulna with dislocation of the radial head from both the proximal radioulnar and radio-capitellar joints. At present in most case scenario all the monteggia fractures in adults operated with ORIF platting but hereby we have study about monteggia fracture managed with CRIF with rush nail compared with ORIF and platting. This study aimed to see the clinical and functional outcome of m Aim- onteggia fracture xation with Rush nail compared to platting in adult. A prospective study was conducted over 6 months of a total of 30 patients Material and Method- with monteggia fracture operated with rush nail and 30 patient operated with platting. Patients were divided by randomized controlled trial. All these 60 patients were followed up for mean duration of 6 months. The postoperative Mayo Elbow Performance Index at the tim Results- e of follow-up ranged from 65 to 100, with twenty-two excellent, ve good, three fair, and no poor results in operated case with rush nail and twenty-three excellent, four good, three fair, no poor result in operated case with platting. The radial head remained in a completely reduced position in twenty-ve patient (86%) and was subluxated in ve patients (14%) in operated case with rush nail and radial head completely reduced position in twenty-eight patient (94%) and was subluxated in two patient (6%) in operated case with platting at the time of the latest follow-up. Radiographically, there were twenty-six good, four fair, and no poor results operated with rush nail. A good radiographic result was obtained in all of the patients who had undergone open reduction and platting within three years after the injury. In overall comparison of Conclusion- clinical, functional and radiological outcome it was found that Rush nail gives superior results than platting.

Humerus nail for tibial reconstruction in adolescent with osteogenesis imperfecta – A rare surgical case report

Osteogenesis Imperfecta (OI) is a rare connective tissue disorder known for excessive bone fragility caused by collagen mutations. The common orthopaedic problems related to bone fragility include frequent multiple bone fractures, progressive deformity of long bones leading to impaired ambulation. Surgical correction of long bone deformities in OI is conventionally done using distraction osteogenesis (illizarov fixator), elastic intramedullary nailing, rigid extramedullary fixation using plates, after osteotomy. Intramedullary fixation appears to be an ideal choice for correction of recurrent deformity in the long bone and the devices used previously include telescoping rods, single or dual non-elongating nails (rush nail, TENS). Recently in a case report of 3 individual patients, a humerus nail has been used to reconstruct femur in adolescents with OI. We report a case of humerus nailing for reconstruction of tibia in an adolescent OI male with excellent outcomes which is first of its kind and not reported previously by any other authors.

A prospective observational study of functional outcome of pott’s fracture managed with operative modalities

Introduction: The movement around the ankle joint is very important because of the cultural practices, which involve squatting and sitting cross-legged. Bimalleolar Pott’s fractures are very common in ankle joint injuries because of the increased incidence of road traffic accidents and industrial trauma. Accurate reduction of fractures around the ankle joint is important for a painless ankle joint. AIM: To study the functional outcome of surgically managed closed bimalleolar fractures of the ankle in adults; to evaluate the restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation; to assess the union of fractures after surgical management; and to achieve stable fixation and early mobilization of the ankle. Materials and Methods: We have evaluated clinical, radiological and functional outcomes of 50 patients treated with different treatment modalities, which include - tension band wiring (TBW), Kirschner (K)-wire, malleolar screw (MS) and cannulated cancellous screws (CCS) for medial malleolus fracture and rush nail, one-third tubular plate, fibular locking plate for lateral malleolus fracture. Results: The present study of 50 patients with ankle fractures treated by open reduction and internal fixation. Excellent results were achieved in 27 (54%) patients, good in 14 (28%), Fair in 5 (10%) and Poor in 4 (8%) patients. The patient with poor results had mild pain with activities of daily living, diminution in the abilities to run and to do work, the reduced motion of the ankle and narrowing of joint space.Conclusion: Closed treatment is often inadequate for restoring the proper biomechanics and anatomical structure of an injured ankle joint, internal fixation is an excellent method. Treating malleolar fractures with the use of anatomic fixation and open reduction was found to be very effective.

A 31-year review of composite radial forearm free flaps for head and neck reconstruction

The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Patients were categorised into three groups for analysis: (1) new oral cancers with a composite radial being the first choice of flap, (2) new oral cancers with a composite radial being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis (ORN) cases. There were 103 CRFFF cases, median (IQR) age 69 (59-80) years, comprising 78 (Group 1), 5 (Group 2) and 20 (Group 3). The CRFFF failure rate was 6% (6/103) and the radius fracture rate was also 6% (6/103), both with 95% confidence interval 2.2-12.2%. Of the 6 radius fractures, 1 underwent surgical management (rush nailing), 1 died in hospital and the others managed with cast immobilisation. Two-year overall survival after surgery for the103 patients was 54% (SE 5%), while 5-year survival was 40% (SE 5%). In conclusion, in spite of the familiarity with other bone flaps such as fibular free flap, DCIA, scapula, and the limited bone stock and potential fracture related morbidity associated with the CRFFF, this flap still has a place in the surgical reconstructive armamentarium.

ASSESSMENT OF OUTCOME IN CASES WITH EXTRAARTICULAR DISTAL THIRD TIBIA FIBULA FRACTURES TREATED WITH INTERLOCKING NAILING OF TIBIA WITH CONCOMITANT FIBULAR FIXATION BY ORIF WITH PLATE OR BY CLOSED NAILING

BACKGROUND- The present study aimed to assess and compare the radiological and functional outcome, union time and complications in cases of extraarticular distal third Tibia bula fractures treated with interlocking nailing of Tibia with concomitant Fibular xation either by ORIF with plate or by closed nailing. METHODOLOGY- This was observational prospective study which was carried out at Department of Orthopedics in Unique Super Speciality Centre, Indore (M.P.) for a period of 1 year on adults belonging to age group between 18 to 75 years of either gender. All the cases were randomly allocated in two groups. During surgery, fracture tibia was managed with the help of interlocking intramedullay nail in all the cases in both the groups whereas bular fracture in group A were managed using ORIF with semitubular plate or reconstruction plate and that in group B was managed using CRIF with rush nail/ square nail/ k wire. RESULTS-There was no statistically signicant association between the complications and the groups (p&gt;0.05), showing that the complications is independent of the groups. There was a signicant improvement in the score at 3 months and 6 months (p&lt;0.05) in both the groups; however, no statistically signicant difference in union time between the two groups (p&gt;0.05). Also no statistically signicant association between the outcome and the groups (p&gt;0.05) was observed. CONCLUSION- The choice of xation for adjunctive stabilization of bula has no effect on the fracture tibia union and the ultimate functional outcome. Closed nailing is better where the soft tissue morbidity is high (as in high velocity trauma and open fractures) and where bones are weak (elderly patients). Other immunocompromised states such as diabetes in which there are higher infection rates with traditional plating techniques.

Distal metaphyseal tibial fractures: Is an IMIL nail an adequate implant? An observational study on the functional and radiological outcome

The purpose of this study is to evaluate the functional outcome as well as radiological outcome of distal metaphyseal tibial fractures treated with intramedullary interlocking nail after 6 months post surgery in terms of degree of functionality preserved and degree of malalignment respectively.This was an observational study conducted with 38 patients. Data was retrieved from the MRD. Patients were clinically assessed at 6 months interval and as and when needed by Karlstorm and Orleud Score. Fracture alignment post operatively and radiological union in two standard perpendicular (AP & Lateral) views were assessed. In patients operated in the past, their immediate post-operative and 6 month follow up x-ray was accessed. Functionality was assessed by available information in the patient chart and from present followup.6 cases (20%) had excellent results, 16 cases (55%) had good results, 7 cases (24%) had fair result (satisfactory/moderate) mostly for minor complaints of knee pain, ankle stiffness. 7 patients were unavailable for assessment of functionality. 1 patient had expired due to natural causes in conclusion Interlocking Intramedullary Nailing for Distal Metaphyseal Tibial Fractures is an acceptable line as it helps with early mobilization of the patient which helps in healing of the fracture and prevents joint stiffness thereby restoring complete motion. The construct is biomechanically stable. Fibular fixation with rush nails predisposed to delayed union, hence plating is recommended or revision of rush nailing to plating when feasible.

Study on Percutaneous Intramedullary Nailing In Adult Diaphyseal Humeral Fractures

Objective: The objective of this research was to evaluate close fixation techniques for fractures of humerus via percutaneous intramedullary nailing.&#x0D; Methodology: This was a prospective study, carried out in Suleman Roshan Medical College Tando Adam Pakistan from January 2019 to January 2020. About 60 patients with humeral shaft fractures were made part of this study with a follow-up period of about 1 to 2 years. The inclusion criteria were humeral fractures that were of less than 7 days prior to surgery, the displacement of fracture &gt;20° in sagittal as well as coronal plane, and the distance measuring &gt;2cm between the two fragments. All patients were treated via the closed fixation technique. Multiple nails that were slender as well as flexible (3-5) were used in the close fixation technique including rush nails (45 patients) and ender nails (15 patients). All the patients within their follow-up periods were evaluated for ROM, pain, or any kind of deformity, and all the patients were assessed radiographically to check the process of bone union.&#x0D; Results: The outcome was analyzed before implant i.e at six months and after the implant was removed. About 86% patients (n= 52) revealed satisfactory outcomes at six months. About 5 patients revealed non-union or delayed union that was healed after 2nd surgery of bone grafting in 3 patients and injections associated with bone marrow in 2 patients. Stiffening of the shoulder was found to be a frequent complication that decreased significantly when the position of nail insertion was changed during the research.&#x0D; Conclusion: The technique of intramedullary nailing displayed many benefits including minimum tissue stress, a quick surgery time, decreased period of hospital stay, and rapid bone union.

A Study of Functional Outcome of Bimalleolar Fracture

The results of bimalleolar ankle fractures are better with emphasis on anatomical reduction of fracture, stable internal fixation, regaining full fibular length and early active pain free mobilization, since the advent of A.O principles of management. This study analyzes the functional outcome of Ankle joint after Internal Fixation of bimalleolar fracture. This study was done to evaluate the functional outcome of ankle joint after internal fixation of bimalleolar fracture, those which were operated with different modalities. Classifications used were Lauge-Hansen Classification and Danis-Weber Classification. Road traffic accident, Twisting injury and Fall from height were major mode of injury. Cannulated cancellous screw, Malleolar Screw and TBW used for medial malleolus and semi tubular plate, cannulated cancellous screw and Rush Nail used for fibula are common mode of fixation. According to Baird and Jackson scoring system out of 40 cases, 92.5% were excellent and good, 5% were fair and 2.5% were poor. Anatomical correlations suggest reduction and stable internal fixation restore the articular congruity of ankle joint results in high percentage of excellent and good results.

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.

Pott’s fracture: Study of functional outcomes of various surgical treatments

Background: Pott’s fractures are very common in ankle injuries because of increased incidence of road traffic accidents and industrial trauma. Anatomical reduction and stable fixation is important for a painless ankle joint. Aim & Objectives: To study functional outcomes of various surgical treatments of pott’s fracture; to achieve stable fixation and early mobilization of the ankle.Materials and Methods: We have evaluated clinical, radiological and functional outcomes of 30 patients treated with different treatment modalities, which include - tension band wiring (TBW), Kirschner (K)-wire, malleolar screw (MS) and cannulated cancellous screws (CCS) for medial malleolus fracture and rush nail, one-third tubular plate, fibular locking plate for lateral malleolus fracture.Results: In this prospective study, 30 cases of Pott’s fractures of ankle were treated by different surgical method. Most common mode of injury was pronation and external rotation injury accounts for 53.34%. 29 cases were treated with open reduction internal fixation and one case associated with plafond fracture treated with external fixator. 15cases of medial malleoli fracture treated with TBW and 14 cases with malleolar / cannulated cancellous screw. Lateral malleoli fractures were treated with rush nail/ fibular plate. We found excellent results in 17 cases, good results in 8 cases, fair results in 4 cases and poor result in 1 case.Conclusion: In this study, after analysing our result, clinical and radiological results has been compared with other published result and found that TBW and fibular plate give excellent results.Level 1 Evidence: Prospective study

Functional And Neurological Outcomes Of Closed Reduction And Percutaneous Pinning In Pediatric Monteggia Fracture

Introduction: The aim of this study was to assess the neurological and functional recovery of children with Monteggia fracture following closed reduction and percutaneous pinning.&#x0D; Methods: It was a descriptive observational study, patients aged from 3 to 15 years with Monteggia fractures are taken in to consideration during the period between 2074/02/01 and 2074/7/30. Participants were selected on the basis of pre-determined inclusion/exclusion criteria. A total of 33 patients were included in the study. The demographics and pre- and post-operative outcomes were recorded in semi-structured proforma. Data entry, synthesis and descriptive analysis were done using MS EXCEL and SPSS version 16.0.&#x0D; Results: Total of 33 patients met the inclusion and exclusion criteria. The mean age was 8.21±3.4 years, with sex ratio (m: f) of 1.75: 1. Majority of the patients (57.58%) injured their left elbow and the most common mechanism of injury was fall while playing (36.36%). According to modified classification system for children, 60.61% had class C and 39.39% had class B Monteggia fracture. Five patients (15.15%) presented with PIN injury. All patients were treated with closed reduction and percutaneous pinning (IM RUSH nail) within 2.27±1.30 days after injury. The average duration of surgery was 62.42±23.55 minutes. The average duration of fracture healing was 5.39±1.6 weeks. Jupiter’s criteria for the evaluation of elbow function was used and at the time of cast removal, 6 (18.18%) had excellent, 10 (30.30%) had good, 13 (39.39%) had fair and 4 (12.13%) had poor functional recovery.&#x0D; Conclusions: This study concludes that most of the pediatric Monteggia fractures (class B and C) can be treated with closed reduction and percutaneous intramedullary nailing using RUSH pins. This technique has very good functional and neurological outcomes with fewer complications.&#x0D; Keywords: children; functional recovery; Intra-medullary nailing; jupiter’s criteria; Monteggia fractures.

A study of functional outcome of bimalleolar fracture after internal fixation

Aim: To analyse the functional outcome of Ankle joint after Internal Fixation of bimalleolar fracture. Materials and Method: This is prospective study done in Krishna medical college and hospital, karad (Satara). In our study 40 cases of bimalleolar ankle fracture were analysed. Classifications used are Lauge-Hansen Classification and Denis-Weber Classification. Road traffic accident, Twisting injury and fall from height are major mode of injury. Cannulated cancellous screw, Malleolar Screw and TBW used for medial malleolus and semi tubular plate, cannulated cancellous screw and Rush Nail used for fibula are common mode of fixation. Results: According to Baird and Jackson scoring system out of 40 cases, 92.5% were excellent and good, 5% were fair and 2.5% were poor. Conclusion: Anatomical reduction and stable internal fixation restore the articular congruity of ankle joint results in high percentage of excellent and good results.

Study of surgical management by internal fixation of bimalleolar fractures

This study has been done to evaluate the effectiveness, functional results and complications following surgical internal fixation of Bimalleolar fractures of ankle joint, In this study 50 patients of fresh bi malleolar fractures of ankle joint treated surgically by internal fixation, studied between may 2017 to February 2018 in mamta general and super specialty hospital, khammam. Surgeries were performed within 5 days average. All cases treated by open reduction and internal fixation, In this study there was 19 cases of abduction, 7 cases of adduction, 16 cases with supination external rotation and 8 cases with pronation external rotation type of injuries with 80% of medial malleolar fracture are treated by malleolar screw and k- wire fixation, the other 20% by tension band wiring, most of the lateral malleolar fractures fixed with one third semi tubular plate amounting to 80% and rush nail have been used in few cases where the fracture is above the syndesmotic level. Anteriomedial approach for medial malleolus and anteriolateral approach for fibula was used in all 50 cases. All the fractures united with a union rate of 94%. Radiological union was possible in 12.2 weeks, weight bearing started from 12 weeks, early ankle stiffness noted in 4 % of cases which was overcome by good physiotherapy and full ankle motion observed in 90% patients. There were one case of non union, two cases of joint stiffness and about ten cases of superficial infections. Functional results according to criteria by Burwell et al. 82% of patients achieved good or excellent results, fair result obtained in 17.5% patient and 5% patient functional result was poor.

A study of 50 cases of mangement of non-physeal forearm fracture in children upto the age of 12 years

Introduction: Injuries to the shaft of the radius-ulna are the most common reasons for children to receive orthopaedic care and are among the most challenging to the orthopaedist because of their complexity and risk of complications. Diaphyseal fracture of both bones of forearm in mature bone are now treated by open reduction and internal fixation. Diaphyseal fractures of the forearm in children are accounting for 6%-10%. Ninety percentages of them are treated conservatively i.e. closed reduction and plaster casting. The remaining of 10% are irreducible and/or unstable fractures, requiring different treatment methods i.e. closed reduction & casting under general anaesthesia, fixation with pins & plaster casting, closed reduction or mini-invasive Intra-medullary nailing, open reduction & Osteosynthesis with plates & external fixators. Aim and Objectives: To identify the factors such as angulation at fracture site, inclination of epiphyseal plate of radius with the proximal fragments, type of fractures etc. with regards to supination & pronation in the patients treated by closed and open methods. Materials and Methods: This is a prospective study of management of 50 patients having non-physeal fractures of radius-ulna in children upto the age of 12 years. All the patients were treated at the Department of Orthopaedics, GMERS Medical College and Hospital, Valsad, Gujarat from 20/05/2015 to 15/08/2018. The follow-up period ranged from 12 weeks to 30 months. Patients were treated with closed reduction and open reduction internal fixation by Intra-medullary nails i.e. a) Rush nail and Plates i.e. a) 3.5mm DCP b) Reconstruction plate c) 1/3rd tubular plate. Result: At final follow-up, for closed methods, 90% patients had excellent results & 6.7% patients had good results. For operative method, 88.2% patients for IM nailing & 66.6% patients for plating had excellent results. Conclusion: Close methods is better than operative methods.

Intramedullary Nailing of Both Bone Forearm Fractures in Children by Rush Nails and Titanium Elastic Nails

INTRODUCTION: Forearm fractures are common upper limb injuries among children and usually treated nonoperatively. Failure of nonoperative treatment, open injuries and multiple fractures are the indications for surgery in paediatric both bone forearm fractures. Intramedullary (IM) nailing is considered as minimally invasive procedure with excellent to fair outcomes but it is not free of complications. We reviewed the results and compared the outcomes of IM fixation by Rush nails with titanium elastic nails (TENs), to understand the risks and complications associated with this procedures. MATERIAL AND METHODS: We performed a retrospective review of all paediatric patients treated for diaphyseal forearm fractures from January 2011 to December 2015. Complications were classified according to modified Clavien-Dindo complication classification system. Outcomes were graded depending upon complication grade along with range of motion of forearm. RESULTS: There was no statistically significant difference for mean time to fracture union between the Rush nailing (10.56 weeks ) group and TENs nailing group (9.85weeks) (P = 0.43). There was no statistically significant difference in outcomes between Rush nailing and TENs nailing group p=0.65. In Rush nailing group outcomes were excellent in 16 (64%), good in 7(28%), fair in 2( 8%) patients and no poor outcome were noted. In TENs nailing group outcomes were excellent in 11 (55%) , good in 6 (30%), fair in 3 (15%) patients and no poor outcomes were noted. CONCLUSION: Fixation of pediatric forearm fractures by intramedullary Rush nails and titanium elastic nails (TENs) are minimally invasive procedures and results are excellent to fair with acceptable complication rates. Since Rush nails are easily available and affordable in developing countries like ours we can prefer Rush nails for intramedullary fixation of paediatric forearm fracture when indicated. Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 10-15

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

Objective: To study the functional outcome of surgically managed malleolar fractures at ankle and to assess the results of complication. Introduction: Ankle fracture is a common injury with potentially significant morbidity associated with it. Regardless of the method of the intervention, main goal is to restore normal anatomy. Complications associated with both conservative and operative management are an important consideration in decision making. Patient selection is very important in deciding the type of management. This paper provides an update to surgical management of ankle fractures. Methodology: Medical records of 96 patients were studied and data was collected which includes the demographic data, fracture details, intraoperative and postoperative details. Then patients were called up for follow-up. The functional outcome of these patients was assessed subjectively using OLERUD MOLANDER ANKLE SCORE (OMA) score. Objective and radiological outcome was assessed using cedell’s criteria. Results: Among the 96 patients we achieved excellent and good subjective results in 60 (62.5%) patients; Good objective result in 72 (75%) patients; Good radiographic results in 80 (83.4%) patients. In our study, patients with unimalleolar fractures had the best outcome. Trimalleolar fractures had the worst outcome. Bimalleolar fracture had intermediate outcome. With regards to lateral malleolar fracture fixation modality, patients with rush nail achieved good to fair radiological and objective outcome with no poor outcomes With regards to medial malleolar fracture fixation modality, patients with Tension band achieved good objective and radiological outcome and there were no poor outcomes. In patients with malleolar screw fixation 62.5 % patients achieved good objective and 75 % patients achieved good radiological outcome. Patients with complications has poorer outcome. In patients with superficial infection the outcome was poorer.