Titanium Elastic Intramedullary Nails Research Articles

Comparison of four surgical methods for pediatric forearm double diaphyseal fractures: a retrospective analysis.

One of the most frequent fractures in children is a double forearm fracture. They make up 26% of children's long bone fractures in the upper extremities and their incidence has increased in recent years. In this study, pediatric patients with double forearm fractures were treated using plate screw, intramedullary K-wire (I-KW), intramedullary titanium elastic nails (TENs), and hybrid fixation (HF) to compare the radiographic and functional results. The printed and digital medical records were retrospectively examined from our hospital's archives after receiving consent from the regional ethics committee. Legal guardians of the patients, who were under the age of 18, gave their informed consent. Based on the surgical procedure used, the patients were split into 4 groups. Double plating was the D-P group, hybrid fixation method was the HF group, intramedullary elastic titanium nail was the TEN group, and intramedullary K-wire was the I-KW group. The study comprised 78 patients in total, with 19 patients in the HF group, 21 patients in the TEN group, 20 patients in the I-KW group, and 18 patients in the D-P group. When the mean operating times of the four approaches were compared, a substantial difference was found. The D-P group's mean operating time (65.2±4.9 minutes) was noticeably longer than those of the other groups (p<0.001). The HF group's mean operating time was 55.93.4 min longer than that of the TENs and I-KW groups, which was statistically significant (p<0.001). In comparison to the other groups, the D-P group's mean intraoperative fluoroscopy time was considerably shorter (6±3 sec) (p<0.001). When compared to the D-P group, it was considerably higher in the HF group (12±2 sec) (p<0.001). In comparison to the TENs (20±4 sec) and I-KW groups (19±5 sec), it was significantly lower in the HF group (p<0.001). In comparison to the HF group, the D-P group's tourniquet use lasted much longer (p<0.001). The TENs and I-KW groups did not use a tourniquet because a mini-incision was made. The D-P group's mean blood loss (110±10 ml) was substantially larger than that of the other groups (p<0.001) in the mean blood loss data. In comparison to the TENs (40±5 ml) and I-KW (40±5 ml) groups, the mean blood loss in the HF group (90±10 ml) was considerably larger (p<0.001). All patients received an above-elbow postoperative cast. The HF group (2 weeks) and the D-P group (2 weeks) experienced significantly less postoperative immobility than the TENs and I-KW groups (4.4 weeks, p<0.001). The four fixation techniques used in the current study for juvenile diaphyseal double forearm fractures produced positive clinical and functional outcomes. The hybrid fixation technique was discovered to be comparable to the other techniques and even beneficial in some ways. So, a safe and efficient treatment option for juvenile diaphyseal double forearm fractures is hybrid fixation.

Outcomes and complications of Titanium elastic nailing for forearm bones fracture in children: our experience in a district general hospital in the United Kingdom.

Intramedullary Titanium elastic nailing (TENS) is successfully used for irreducible and displaced forearm bone fractures in children. The purpose of this study was to report the potential complications and functional outcomes associated with paediatric forearm fractures treated with TENS nails. We retrospectively reviewed 65 children with displaced forearm bone fractures treated by TENS nailing with a mean follow-up of 5.84 months (4-12). Data detailing patient demographics, fracture characteristics, associated fractures, injury surgery interval, grade of the operating surgeon, methods of fixation, time to union, the timing of removal of the nail, and complications were collected and analysed. The mean age in our study was 9.13 years. 92% had fractures of both radius and ulna, 83.3% had fixation of both bones, and 16.7% had single bone fixation only. Open reduction was required in 38.5% of cases. The average time to fracture union was 10.34 weeks (6-20). The average time of implant removal was 20.12 weeks (9-32). We observed an overall complication rate of 41.5%. We noted a higher (56% vs 32.5%, p=0.059) complication rate in open reduction cases. According to the Price criteria, we had excellent to good results in over 98% of patients despite a slightly higher complication rate. Titanium elastic nailing is a safe, reliable method of internal fixation for irreducible or unstable fractures of both bones of the forearm in children. Open reduction of fracture was associated with higher complications. Despite higher overall complications, we noted excellent functional results in most cases.

Finite Element Analysis of Mechanical Characteristics of Internal Fixation for Treatment of Proximal Femoral Osteolytic Lesions in Children.

Clinically, it is very difficult to prevent pathological fracture caused by high recurrence rate of osteolytic disease of proximal femur in children. At present, there is no consensus in clinical studies of which internal fixation method can significantly reduce the probability of recurrence of pathological fracture. The study aims to research the mechanical properties of different internal fixations in the treatment of osteolytic lesions of proximal femur in children by finite element analysis, and to find out the optimal treatment. Based on finite element analysis, the osteolytic disease models of the femoral neck and intertrochanter in a child (8-year-old, boy) were established respectively, and different internal fixation models (plate and titanium elastic intramedullary nails, TENs) were assembled. For the osteolytic lesion of the femoral neck: model A1 was assembled with a plate; model A2 with two TENs crossing the physis; model A3 with two TENs without crossing the physis. And for pertrochanteric osteolytic lesion: model B1 was assembled with a plate, model B2 with two TENs crossing the physis and model B3 with two TENs without crossing the physis. The Eccentric bearing load, torsional restraintal restraint of calcar femorale and composite load were analyzed for each models. When the yield strain of each model is reached, the stress concentration points are located in the proximal and distal femoral calcar. In the model of femoral neck lesions, the failure load of model A1 and model A2 are the same (1250 N), and the failure load of model A3 (980 N) is significantly lower than that of the former two; in the model of intertrochanteric lesions, the failure load of model B2 is the largest (1350 N), and the failure load of model B1 (1220 N) is lower than that of model B3 (1260 N), but both are smaller than that of model B2. Through finite element analysis, TENs through the epiphyseal plate, is found to be the better internal fixation method for femoral neck lesions and intertrochanteric lesions under two different working conditions. The results of clinical correlation study provide new biomechanical information for orthopedic doctors to consider different treatment options for osteolytic lesions of proximal femur.

STUDY OF DISPLACED MIDSHAFT CLAVICLE FRACTURES TREATED WITH INTRA MEDULLARY TITANIUM ELASTIC NAIL SYSTEM AND ITS FUNCTIONAL OUTCOME

Introduction: Fractures of the clavicle, which primarily occur in young males, constitute 2.6–4% of all fractures in adults. A male dominance of approximately 70% has been reported. The most frequent injury mechanism is a direct fall on the shoulder. Fractures are often sustained during sports activities or trafc accidents. The majority (69–82%) of fractures occur in the mid-shaft of the clavicle, followed by 12–26% in the lateral part and 2–6% in the medial part. Aims: This study is aimed to assess the functional Outcome of intramedullary titanium elastic nail system for Displaced Clavicle Fracture.Materials And Methods:The present study was analytical study. This Study was conducted from one and half year at Department Of Orthopaedics Jagannath Gupta Institute Of Medical Sciences And Hospital, Kolkata. Result: In our study, 1 (5.0%) patient had Bb Leg Injuries and 2 (10.0%) patients had I/L Scapula Spine in Associated Injuries which was not statistically signicant (p=0.6530). Conclusion: We found that, ESIN is safe and minimally invasive with good patient satisfaction, cosmetic appearance, and overall outcome.

Titanium Elastic Stable Intramedullary Nailing for the Repair of Long Bone Fractures in Dogs

Background: Elastic stable intramedullary nailing has become a widely accepted, standard surgical technique for the repair of long bone diaphyseal fractures in children and adolescents however, references for its use in veterinary practice are still rare. Methods: The present study was conducted on ten clinical cases, selected randomly irrespective of their age, sex and breeds; diagnosed with long bone diaphyseal fractures. Titanium elastic intramedullary nailing was performed in all the cases. Clinical, orthopaedic and radiographic examinations were performed pre-operatively, just after surgery and at 15th, 30th and 60th post-operative days. Result: There was an increase in the mean weight bearing score during standing and walking from 0th day to 60th post-operative day. Post-operative radiographic examinations revealed increase in the mean values of bone formation score and bone union scores. The nails were removed easily in all the cases on 60th post-operative day. Five cases had complications; delayed wound healing (n=1) and slight nail migration from insertion site (n=4) which were managed conservatively and by cutting the extra lengths of the migrated nails. The clinical outcome on the basis of functional limb usage was excellent in seven cases, good in two cases and fair in one case. Overall, titanium elastic stable intramedullary nailing had good efficacy with respect to weight bearing in dogs without any systemic adverse effect.

Comments on “Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing”—The need for a large multi-center study to compare locked intramedullary nailing, titanium elastic intramedullary nailing and plate fixation for treatment of adolescent forearm fractures

Comments on “Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing”—The need for a large multi-center study to compare locked intramedullary nailing, titanium elastic intramedullary nailing and plate fixation for treatment of adolescent forearm fractures

Elastic stable intramedullary nailing using Titanium elastic nails for the management of tibial fractures in dogs

The present study was conducted on six dogs, selected randomly irrespective of their age, sex and breed; diagnosed with tibial diaphyseal fracture. For the repair of fracture of tibia, Titanium elastic intramedullary nailing was performed in all the cases. Clinical, orthopaedic, radiographic and haemato- biochemical examinations were performed pre-operatively, just after the surgery, at 15th, 30th and 60th post-operative days. Gradual improvement in weight bearing on the operated limb was shown by all the cases starting from 4th to 7th post-operative day followed by complete weight bearing on 30th post-operative day in four cases and all the dogs had shown complete weight bearing without lameness while moving on 60th post-operative day. Satisfactory fracture alignment was shown in the post-operative radiograph at 15th, 30th and 60th days after the surgery. Slight migration of the nails at site of insertion in three cases were observed on clinical examination, which were easily managed by cutting the extra length of the nail outside the skin along with regular antiseptic dressing of the wound. The haemato-biochemical parameters were found within the normal clinical range at different time intervals of examination. On the basis of this study, it was found that the Titanium elastic stable intramedullary nailing has good efficacy for the repair of diaphyseal fracture of tibia without having any systemic adverse effects in dogs.

Can titanium elastic nails deliver a knockout punch against precontoured locking plates in handling displaced middle third clavicle fractures?

Background: Plating is the gold standard for displaced middle third clavicle fractures, which holds true at least for comminuted fractures with a fair share of complications. For displaced fractures without comminution, intramedullary titanium elastic nailing system is an emerging option which claims similar success rates with fewer complications. There is a deficit in data pertaining to prospective trials supporting such claims which has propelled us to carry out this study. This study aims to compare the functional outcome and complication rates between precontoured locking plates and titanium elastic nails for displaced clavicle fractures. Materials and Methods: A prospective cohort study carried out on 56 patients with displaced clavicle fractures without comminution treated either by nailing (with open reduction through minimal incision at fracture site) or plating, and the results pertaining to their functional outcome and complication rates were compared. Results: Nottingham clavicle score and Constant Murley score were calculated at 6, 12, and 24 months along with comparison of complication rates. Conclusion: The functional outcome scores recorded significant differences at 6- and 12-month periods between the groups, which minimized at 24 months. Complication rates were significantly different between the groups. These results of functional outcome and complication rates point toward titanium nailing as an attractive alternative to plating for a comminuted displaced middle third clavicle fractures.

Alternative and off-label use of Titanium Elastic Nail® in acute adult humeral diaphyseal and subcapital fractures

Traumatic adult humeral diaphyseal fractures can be difficult to deal with in geriatric patients. Three examples are summarized in using Titanium Elastic Nails® (TEN) in adult patients as an efficient alternative and an off-label strategy in treating diaphyseal as well as subcapital humeral fractures. A 75 years old adult female patient suffering from a motor neuron disease with flail arm syndrome and symmetric limp paraparesis of the arms with missing reflexes of arms and legs. Plain film radiographs demonstrated a multifragmentary fracture of the diaphysis of the right humerus with slight dislocation. After fail of an initial conservative therapy attempt, the fracture was splinted intramedullary with two titanium elastic nails until fracture healing. A 59 years old female patient slipped and fell at ground level on her left side. An oblique diaphyseal humeral fracture was found. Due to an anticoagulation with clopidogrel and a major rotator cuff lesion an immediate operation was performed by minimally invasive intramedullary titanium elastic nailing. Two and a half months after surgery the fracture was fully consolidated, full weight bearing was possible four months after the surgery. The implant removal was performed five and a half months after the initial trauma without postoperative complications with full recovery of the patient and restitutio in integrum. A young female skier fell on the ski field and sustained a subcapital humerus fracture on the left side. As a primary wish of the patient getting the most minimally invasive and scar free operation, an off-label use of Titanium Elastic Nail® (TEN) was chosen and performed. The postoperative stability did allow an adequate early functional training with initially passive and active assistive motion. In conclusion, intramedullary titanium elastic nailing can be a sufficient minimally invasive technique in patients with secondary diagnoses influencing operability, bone structure and fracture healing.

Paediatric diaphyseal forearm fractures: Is titanium elastic nailing a safe option?

Paediatric forearm fractures are common injuries accounting for 40% of all the fractures in children. They are traditionally treated conservatively with casting. However there has been short and long term complications associated with such treatment and in recent times, closed reduction and flexible nailing has shown favourable clinical outcomes. In this prospective study, we evaluated functional outcome in closed forearm diaphyseal fractures of children and adolescents treated with titanium elastic intramedullary nails. All cases achieved bony union at an average of eight weeks and excellent functional outcome without significant complications. Nails were removed under anaesthesia after radiological union. Intramedullary nailing with elastic nails is an effective method of treatment for these unstable diaphyseal fractures of forearm in children and adolescents.

Comparison of Open Reduction and Internal Fixation with Plate and Titanium Elastic Intramedullary Nail in Treating Pediatric Humeral Fracture

ObjectiveTo investigate the therapeutic efficacy of titanium elastic intramedullary nail (TEN) and open reduction and internal fixation with plate (ORIF) in the treatment of humeral fracture in children.MethodsA retrospective study was carried out in a total of 69 patients who were admitted to the hospital from January 2013 to December 2018. These patients, including 41 males and 28 females, were aged from 6 to 12 years old with a median of 8 years. These patients were diagnosed with humeral fracture and underwent the surgery of ORIF (n = 22) or TEN (n = 47). The intraoperative bleeding, operation time, length of stay (LOS), and fracture healing time were compared between the two groups. The therapeutic effect was assessed by the shoulder range of motion, the elbow range of motion, the UCLA shoulder function score, and the Mayo elbow performance score (MEPS) 6 months after the surgery.ResultsThe intraoperative bleeding (97.20 ± 27.83 mL vs 185.60 ± 37.50 mL, P < 0.05), the operation time (53.70 ± 11.87 min vs 73.50 ± 13.33 min, P < 0.05), and the fracture healing time (9.30 ± 4.23 weeks vs 13.45 ± 3.67 weeks, P < 0.05) in the TEN group was significantly decreased than those in the ORIF group. There was no significant difference in the LOS between the two groups. The length of follow‐up is 3 and 6 months. The shoulder range of motion (110.88° ± 15.82° vs 98.37° ± 16.22° at 3 months and 162.88° ± 17.29° vs 117.65° ± 19.38° at 6 months, both P < 0.05), the elbow range of motion (105.23° ± 2.81° vs 87.12° ± 4.73° at 3 months and 137.47° ± 4.82° vs 109.67° ± 5.83° at 6 months, both P < 0.05), and the UCLA shoulder function score (28.58 ± 4.74 vs 21.64 ± 7.23 at 3 months and 33.05 ± 3.27 vs 25.78 ± 3.87 at 6 months, both P < 0.05), and the MEPS (80.76 ± 3.53 vs 65.33 ± 9.43 at 3 months and 97.48 ± 1.23 vs 88.22 ± 3.65 at 6 months, both P < 0.05) in the TEN group were greater than those in the ORIF group. In the TEN group, complications occurred in three of 47 cases (6.38%), including one case (2.13%) of bone nonunion and two cases (4.25%) of irritation response around the nail. In the ORIF group, complications occurred in four of 22 cases (18.18%), including one case (4.55%) of delayed healing, one case (4.55%) of deep infection, and two cases (9.08%) of radial nerve injury. The complication rate was not significantly different between the two groups.ConclusionTEN can be a good technique for the treatment of humeral fracture in children, with the advantages of less intraoperative bleeding, shorter operative time, quicker healing, and better recovery of shoulder range of motion and elbow range of motion.

Comparative study on the complications of antebrachium fractures treated with flexible nailing in paediatric and adolescent age group

Background: Antebrachium fractures in paediatric age group, which are unstable are more commonly treated nowadays using intramedullary titanium elastic nailing. Recent studies have showed a higher complication rates in adolescent population when compared to the paediatric counterpart. The aim and objective of this study is to compare the complication rates and outcome in paediatric and adolescent population treated using flexible nail. Methods: An ethical committee approved study was conducted in Rajah Muthiah Medical College, Chidambaram from May 2018 to September 2020 on both bone forearm fractures in paediatric and adolescent population. In our study 20 cases of both bone forearm fractures, of which 10 belonging to paediatric age group (age less than 10 years) and 10 cases belonging to adolescent age group (age more than 10 years) treated with flexible intramedullary nail (TENS). These cases were followed up for period of 1 year and complications were quantified on the basis of Clavien – Dindo classification. Outcomes were analysed based on Martus et al. grading system. Results: Out of 20 forearm fractures treated with tens nail in each age group, mean age was found to be 13.6 years in adolescent group and 9.2 years in paediatric group. Mean follow up period were42 weeks in adolescent category and 40 weeks in paediatric category. Average time and duration from the point of injury to the surgical procedure was 2 to 3 days in both groups. Closed reduction and internal fixation with tens nailing was done in 13 cases (8 paediatric and 5 adolescent group) and open reduction was needed in the remaining 7 cases (2 paediatric and 5 adolescent). The overall result of our study showed that complications were slightly higher in adolescent age group, when compared to the paediatric counterparts. P value between the two groups was not significant. Conclusion: Tens nailing is an excellent technique for paediatric and adolescent fractures of forearm with very good functional outcome. Even though complications were seen in adolescent age group, it was significantly lower than those associated with other surgical techniques. However, with lesser complication rate in paediatric age group, we conclude that in fractures requiring surgical fixation, TENS nailing is more advantageous than other surgical options.

Mid-term outcomes of surgical treatment in fractures in patients with osteopetrosis.

Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.

A prospective study of functional outcome of closed displaced mid-shaft clavicle fractures treated with intramedullary titanium elastic nail system

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Clavicle fractures are most common injuries in young and active individuals, especially those who participate in sports where high-speed falls (e.g., bicycling, motorcycles) or violent collisions (e.g., Football, hockey) are frequent. In contrast, in children and elderly, they are related to falls, and they account for approximately 2.6% of all fractures. The most common site of fracture is a middle-third shaft; it accounts for 80% of all clavicle fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study carried in 20 patients with simple mid third clavicular fractures, who were treated with closed intra-medullary fixation with TENS nailing. Post-operatively range of movements, ability to get back to routine work were assessed and noted. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of the study, all the 20 patients in the follow-up group with 14 male and 6 female patients. The mean age was 34.9 years (between 22-55 years) in the group. The mean time interval between injury and surgery was 3.55 days (range 1-6 days). All the patients are achieved clinical and radiological union at a mean of 8.6 weeks (range, 6-12 weeks).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus, the intramedullary fixation of a displaced midshaft clavicle fracture is a safe minimally invasive technique. The present study advises the use of minimally invasive antegrade titanium elastic nail for fixation of displaced midshaft clavicle fractures. Although, for comminuted fractures plating remains the procedure of choice.&lt;/p&gt;

FUNCTIONAL OUTCOME OF FRACTURE SHAFT OF FEMUR IN PEDIATRIC AGE GROUP TREATED WITH TITANIUM ELASTIC NAILING SYSTEM

Femoral shaft fractures are common fractures in paediatric age group. In children, fractures of the femoral shaft have been traditionally treated mostly by conservatively immobilization in a Spica cast, either immediately or after a period of traction. But this safe form of treatment has major drawbacks. The management of paediatric femoral shaft fractures gradually has evolved towards a more operative approach in the past decade. Elastic stable intramedullary nailing (ESIN) or Titanium elastic nailing system (TENS) is a recent technique which allows stable reduction, maintenance of reduction and early mobilization. . Aim of study is to assess the functional outcome of fracture shaft of femur in pediatric age group treated with titanium elastic nailing system. It is a prospective study which was conducted in the all children between 5-14 years of age with diaphyseal fractures of femur. Outcome of fracture shaft of femur in pediatric age group treated with titanium elastic nailing system was studied studied by observing following, Type of reduction among children with diaphyseal fractures of femur, .Duration for union after surgery , Range of motion after surger, weeks of Weight Bearing started , Limb length discrepancy, Malalignment . From present study we conclude that femur diaphyseal fracture in children between 5-14 years of age can be effectively managed with titanium elastic nails. TENS offers a biological, minimally invasive method of treatment for fracture shaft of femur in children with advantages of sufficient axial stability, early mobilization and more rapid return to function. this technique yields higher rate of excellent functional outcome.&#x0D; Keywords: Femur, Diaphyseal Fracture, Children, TENS

Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.&lt;/p&gt;

Evaluation of pediatric femoral shaft fractures managed with intra-medullary titanium elastic nails [TENS]: A prospective study

Evaluation of pediatric femoral shaft fractures managed with intra-medullary titanium elastic nails [TENS]: A prospective study

To study the total duration of union following pfixationi with titanium elastic nail

Result: Unioni was seen at 12-18 weeks postoperatively with-mean 13 weeks postoperatively in study. “P value” less than 1 that suggest that union time is not associated with type of reduction. Conclusion: Titanium elastic Nail is a safe, effective and valuable technique for selected cases. Titanium elastic intramedullary nailing techniques have advantages like less soft tissue injury, shorterl operating time and hospital stay, more cosmetic satisfaction and minor surgery needed to remove the implant.

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

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

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

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