Titanium Nails Research Articles

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN.A randomized, controlled clinical trial included patients, aged 5–15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN®, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes.Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied.

Mini-Invasive Intramedullary Fixation of Displaced Midshaft Clavicle Fractures with an Elastic Titanium Nail.

The treatment of completely displaced midshaft clavicle fractures is still controversial, but surgical treatment provides a shorter recovery period and higher union rates than nonoperative treatment with a sling1-5. Even though the literature does not clearly support surgery for these fractures, surgery is becoming more frequent6. Elastic stable intramedullary nailing (ESIN) with a titanium nail is a well-documented mini-invasive procedure with functional outcomes comparable with those of plate fixation after 1 year but a high rate of implant removal of up to 80%6-8. The ideal injury for ESIN is a fracture without comminution that is available for surgery within a couple of days. ESIN is also a good option for fractures with comminution, but a somewhat slower functional recovery during the first 6 months should be expected. The patient is placed in beach-chair position with the fluoroscope placed on the injured side or cranially in relation to the fracture. The surgeon pushes the skin gently with his/her index finger at the jugular fossa before incising it. This places the skin incision inferior to the implant. A 1 to 2-cm incision down to the bone is then placed about 1 to 2 cm lateral to the sternoclavicular joint. A unicortical entry hole is made at the medial end with a 2.5-mm drill bit and then widened and directed laterally with an awl. Two reduction forceps are placed percutaneously and used by the assistant to align the main fragments. The nail is passed with oscillating movements until it is secured into the lateral fragment. If it is not possible to obtain a closed reduction, an open reduction is performed. The nail is cut short down to the bone, and the myocutaneous layer and skin are closed with sutures. Five to 10 mL of bupivacaine is injected into the fracture area for postoperative pain management. The arm is placed in a simple sling for comfort. A non-weight-bearing active range of motion of <90° is encouraged. Closed completely displaced midshaft clavicle fractures can be treated operatively or nonoperatively with a sling. Superior plate fixation is well documented, but use of anterior or several mini-fragment plates is also an option. There are several intramedullary implant techniques, but most require an open reduction. Most intramedullary implant methods are open procedures, whereas closed reduction and internal fixation is possible with ESIN. This ensures preservation of the fracture hematoma and no periosteal stripping, in contrast with the open intramedullary techniques. The nail enters the fracture medially, which decreases the chance of perioperative pulmonary or neurovascular injury. The procedure is less time-consuming than plate fixation, the result is cosmetically superior, and the functional outcomes after 1 year are equal. When ESIN is used for fractures without intermediary fragments, the functional recovery time is equal to that after plate fixation, although it is longer when used for fractures with intermediary fragments8.

New type of sutured titanium wire combined with titanium nail internal fixation for correction of serious old medial canthus deformity

To evaluate the effectiveness of a new type of sutured titanium wire combined with titanium nail internal fixation in correction of serious old medial canthus deformity. Between March 2012 and June 2015, 18 patients with unilateral serious old medial canthus deformity were treated. There were 14 males and 4 females. The patient's age ranged from 23 to 62 years (mean, 42 years). The causes of deformity included accident injury in 10 cases, boxing injury in 4 cases, sharp device scratching in 3 cases, and animal bite in 1 case. All patients had been treated with suture or steel wire fixation in other hospitals to correct the medial canthus deformity and the deformity recurred. The interval between this operation and the first operation was 6 months to 2 years (mean, 16 months). The nasal root or medial canthus skin scar incision was used as the operative approach, and the adhesion of the medial canthus ligament to the adjacent tissues was fully loosened, then the tail end of the new type sutured titanium wire was fixed to the residual end of the medial canthus ligament. After passing through the scar tissue, the needle end of wire was fixed on the titanium nail in the bone wall of anterior lacrimal crest. The position and shape of the medial canthus angle was determined by adjusting the tightness of titanium wire. All incisions healed by first intention. All patients were followed up 6-12 months (mean, 10 months). In 16 cases, the medial canthus deformity was obviously corrected, and the appearances of bilateral eyes were basically symmetrical, without exposure of titanium nail and titanium wire. The medial canthus was retreated at 2 mm after 6 months in 2 cases, who were satisfied with their appearance without reoperation. Application of the new type of suture titanium wire combined with titanium nail in the correction of serious old medial canthus deformity can achieve good effectiveness with the low recurrence rate.

TEN versus external fixator in the management of pediatric diaphyseal femoral fractures: evaluation of the outcomes

Over the last 20 years, the incidence of pediatric diaphyseal femoral fractures was increased, due to changes in the children's daily activities. The healing times are different according to the chosen treatment and to other factors such as age, type of fracture, involvement of the soft tissues, and concomitance with other injuries. From 2000 to 2015, 38 pediatric patients with diaphyseal femoral fractures were surgically treated and enrolled in the study. The average age of the patients was between 3 and 15years. Twenty-two patients were treated with endomedullary titanium nails (TEN) and the other 16 with external axial fixators. Comparing the two groups, radiographic images were taken to assess the fracture reduction and consolidation. The average follow-up was 14months. The average time needed to remove the TEN nails was 5months; while 2.5months was the time to remove the external fixator. At the final follow-up, there were no differences between two groups in term of significant rotation defects, angulation, growth, and/or nonunion. This study showed that TENS and external fixation have similar results in term of fracture healing and complication, even if patients treated with TENS are more satisfied.

Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia.

ObjectivesIntramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia.Patients and methodsSixty-two patients (26 females, 36 males) were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient.ResultsTitanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p = .4498). Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p = .0306 and p < .001, respectively). Preoperative SF-36 physical component and KSS scores were significantly lower in patients who had removal of titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores.ConclusionIn conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients.

Peer review report 2 on “Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia”

Peer review report 2 on “Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia”

Peer review report 1 on “Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia”

Peer review report 1 on “Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia”

Influence of screw combination and nail materials in the stability of anterograde reamed intramedullary nail in distal femoral fractures

Intramedullary nailing (IM) is a technique universally accepted to treat femoral diaphyseal fractures. The treatment of fractures located in the distal third remains a controversial issue though. A finite element model of the femur has been developed, analyzing distal fractures with several gap sizes combined with different interlocking combinations of distal screws with one oblique screw proximally to stabilize the intramedullary nail. The mechanical strength of the nail against bending and compression efforts was also studied. Beside the FE simulations, a clinical follow-up of 15 patients, 6 males and 9 females, with mean age of 53.2 years was carried out. Localizations of fractures were 10 in the right femur and 5 in the left femur, respectively.A fairly good correspondence agreement between clinical results and the simulated fractures in terms of gap size was found. Non-comminuted fractures had a mean consolidation time of 20.5 weeks (4.8 months), a tendency corresponding well to the mobility obtained in the FE simulations; Comminuted fractures on the other hand exhibited a higher mean consolidation period of 22.2 weeks (5.2 months) secondary to the excessive mobility at fracture site obtained by means of FE simulations.The best stability at fracture site was found for the system with three distal screws and the system with two distal screws placed medial lateral. The highest leverage of distal screws was obtained maximizing the distance between them and choosing the coronal plane for their orientation. The results obtained with both nail materials (stainless steel and titanium alloy) show a higher mobility when using titanium nails. Steel nails provide stiffer osteosyntheses than the titanium nails.In conclusion, the best screw combination in terms of stability to produce fracture healing and the least difficulties during treatment is the one which had one oblique proximal screw with two distal lateral screw implanted in the coronal plane.

Influence of gap size, screw configuration, and nail materials in the stability of anterograde reamed intramedullary nail in femoral transverse fractures

Femoral shaft fractures are among the most severe injuries of the skeleton. They are associated with high morbidity and mortality. The most appropriate treatment depending on the type of fracture and location level should be chosen.A finite element model of the femur has been developed, analyzing various types of fractures in the subtrochanteric and diaphyseal supracondylar area, with several gap sizes, being stabilized with a single combination of screws for the intramedullary nail. The mechanical strength of the nail against bending and compression efforts was studied comparing two materials for the nail: stainless steel and titanium alloy.Beside the finite elements (FE) simulations, a clinical follow-up was carried out, considering a sample of 55 patients, 24 males, and 31 females, with mean age of 52.5 years. Localizations of fractures were 22 in the right femur and 33 in the left one, respectively.A good agreement between clinical results and the simulated fractures in terms of gap size was found. Non-comminuted fractures have a mean consolidation time of 4.1 months, which coincides with the appropriate mobility at fracture site obtained in the FE simulations, whereas comminuted fractures have a higher mean consolidation period estimated in 7.1 months, corresponding to the excessive mobility at fracture site obtained by means of FE simulations.The obtained results between both nail materials (stainless steel and titanium alloy) show a higher mobility when using titanium nails, which produce a higher rate of strains at the fracture site, amplitude of micromotions and bigger global movements compared to stainless-steel nails. Steel nails provide stiffer osteosyntheses than the titanium nails.In conclusion, anterograde locked nail is particularly useful in the treatment of a wide range of supracondylar fractures with proximal extension into the femoral diaphysis.

Evaluation of surgical fixation of paediatric diaphyseal long bone fractures in lower limb with elastic stable intramedullary nailing (Esin)

Femoral shaft fractures account for 1.6% of all paediatric injuries. The best treatment for children between five to sixteen years of age is still questioned. patients in this transitional age group have high risk of shortening and mal union when conservative measures are used Fixation with flexible intramedullary nails have become a trendy technique, for stabilizing femoral fractures in school aged children. The present study consisted of 25 cases with diaphyseal lower limb fractures of either gender within age group 5-16 years, admitted in Orthopaedics Department of a tertiary care hospital of Punjab and were treated with elastic stable intramedullary nail. RTA accounted for 92% cases. Isolated femur fracture was seen in 40% cases. 8% cases also had ipsilateral tibial fracture with it & 52% had only tibial shaft fractures. Transverse fracture was observed in 56% cases. All cases were fixed with elastic titanium nail. Minor complications, as per Flynn’s criteria were seen in 12% cases. No case developed any major complication. Excellent results were obtained in 76% cases and satisfactory results were obtained in the remaining 24% cases.

Patient-Specific Finite-Element Analysis of Three Intramedullary Nails for Tibiotalocalcaneal Fusion

Category: Ankle, Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure for patients with severe osteoarthritis and other degenerative ankle conditions. Oftentimes, an intramedullary (IM) nail is implanted across the joints and then fixed with tibial and calcaneal screws. Maintaining compression and load sharing are both largely desired to promote fusion via primary bone healing; however, compression can be lost due to small amounts of bone resorption and IM nails are now being made from carbon-fiber epoxy to minimize stress shielding. To date, no one has been able to directly characterize or compare the specific amount of these parameters across nails in a single model. The purpose of this study is to compare influence of nail design and materials for compressive and load-sharing properties using a patient-specific finite-element model. Methods: A titanium nail, a pseudoelastic nickel-titanium nail, and carbon fiber-epoxy nail were investigated for (1) load sharing between the nail body and tibia under gait loading and (2) compression loss as a function of resorption in the talus. A patient- specific model of the ankle, both in geometry and material properties, was generated from a quantitative computed tomography (QCT) scan of a healthy leg. The models were segmented and meshed using SCANIP and exported into ABAQUS for finite- element analysis. Compression in the nickel-titanium nail was simulated by pre-stretching the pseudoelastic compressive element. Conversely, compression in the titanium and carbon-fiber nails were generated by giving the nail jacket an orthotropic contraction coefficient in the model. After compression was set, each nail was subjected to an applied gait load that peaked at 1121 N. Resorption was simulated using a thin compressible layer of bone in the talus and decreasing the modulus and Poisson’s ratio. Results: Surprisingly, the carbon-fiber nail showed similar stress shielding to the titanium nail, with 72% and 77% of the stress being transferred through the devices instead of the ankle, respectively. Even though carbon fiber-epoxy has a significantly lower modulus than titanium (75 GPa vs 110 GPa), the overall stiffness of the nails was still much greater than that of bone (~30,000 N/mm vs. ~44,000 N/mm vs. ~3,000 N/mm, respectively). The pseudoelastic nail only shielded 32% of the stress values by comparison. For the titanium and carbon-fiber nails, over 85% of the initial compression provided by the nail drops with 0.10 mm of resorption. The pseudoelastic nail maintained 90% of its initial compression after 0.10 mm of resorption. Conclusion: IM nail design and materials played a significant role in maintaining compression and load sharing. The pseudoelastic nail had the lowest degree of stress-shielding (32%) and maintained compression for over 0.10 mm of simulated resorption. Constant compression and the avoidance of “resorption gapping” is paramount to drive primary bone healing in joint fusions due to lack of periosteal/endosteal anatomy crossing the fusion site, thus impairing the ability for secondary bone healing (callus healing). This model allows for direct comparison between devices and can be used pre-operatively to predict patient-specific performance and help aid in device selection for TTC fusion.

Management of Pediatric Both Bone Forearm Fractures With Titanium Elastic Nails: A Cost Cutting Measure

Pediatric forearm fracture is a common injury. The displaced fractures, and unstable fractures are many a time treated with intramedullary elastic nails. The flexible titanium nails are easy to insert but increases the treatment cost. To minimize cost, we are routinely using single nail with a slight modification in the surgical procedure yet stabilizing both the bones with comparable results.

Clinical experiences in the use of a gentamicin-coated titanium nail in tibia fractures

Despite the improvement of surgical techniques surgical site infections (SSIs) still remain clinically challenging in high risk patients undergoing osteosynthesis for tibia fractures. The use of an antibiotic coated implant might reduce the adhesion of bacteria on the implant surface and could therefore reduce the rate of implant-related infection or osteomyelitis.A gentamicin-coated tibia nail was evaluated in a prospective study. Four centers enrolled 100 patients (99 treated) with fresh open or closed tibia fractures, or for non-union revision surgery and followed them for 18 months. Data collected included infection events, radiographs, SF-12, EQ-5D, Iowa Ankle score, and the WOMAC questionnaire.Sixty-eight of the 99 treated patients suffered from a fresh fracture, while in 31 patients, the intramedullary nail was implanted for revision purposes, including non-unions due to infection. Fifteen (22%) of the fresh fractures were GA Type III. The follow-up rate was 87% and 82% at 12 months and 18 months, respectively.Deep surgical site infections occurred in 3 fresh fractures and two in revision surgeries. We did not observe any local or systemic toxic effects related to gentamicin during this study.The use of the antibiotic coated nail is an option in patients with a high infection risk, like open factures or infected non unions, in the prevention of the onset of an implant-related infection or osteomyelitis.

Functional Outcome of Intramedullary Nailing with Rush Pin for Pediatric Both Bone Fractures of Forearm in Western Hilly Nepal

Introduction: Both bone diaphysis fracture of forearm is common in children of hilly area in Nepal because the children climbs tree and cliff for playing and cutting grass. Close reduction and casting is the preferred method of treatment these fractures but the chances of re-displacement is very high. Intramedullary nailing with titanium elastic nails or rush pins is widely accepted these days with good outcome. Titanium nails are popular in western world but is costly whereas rush pins are cheap and are preferred in developing world. The aim of this study was to evaluate the functional outcome of intramedullary rush pin for pediatric both bone fracture of forearm.&#x0D; Methods: In this retrospective, observational study done from 1st of February 2017 to 31st of March 2017, a total of sixty patients with both bone fractures of forearm were treated with intramedullary rush pin and followed up for six months for evaluation of functional outcome. T-test and Chi-square tests were done.&#x0D; Results: Closed reduction and internal fixation was done in 48 (80%) patients. Mean age of the patients was 9.23 year (SD=2.77). Fifty-six (93.3%) patients were male with a significant difference (p&lt;0.001). With price et al. grading system, 49 (81.7%) patients had excellent results, nine (15%) had good and two (3.3%) patients had fair results. There was no major complication. Mean time to implant removal was 24.16 weeks (SD=1.62) from the time of surgery with range of 20 to 28 weeks. Among transverse and oblique fractures, patients with transverse fracture were likely to have better outcome (p=0.04).&#x0D; Conclusion: Intramedullary nailing with rush pin gives excellent to good functional outcome in majority of the cases without major complications at low cost for management of both bone fractures of forearm in children.

Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Management of pediatric femoral shaft fractures continues to evolve with time with flexible intramedullary nailing being one of the options to treat a specific age group of children. Grey zone exists concerning the cost effectiveness and appropriate timing of nail removal in treating such fractures. The objective of the study was&lt;strong&gt; &lt;/strong&gt;to evaluate the treatment outcome of fracture shaft of the femur in children in the age group of 5- 12 years with flexible intramedullary nail&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study comprised of 30 consecutive cases of acute fractures of the femoral shaft in children of the age group of 5 to 12 years. Only closed fractures of the mid-diaphyseal region of the femur were included while supracondylar, subtrochanteric and pathological fractures were excluded. Flexible intramedullary nails of stainless steel (n=24) or titanium (n=6) were used for fixation of these fractures.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Evaluation of the results was done according to the criteria by Flynn et al. 21(70%) out of 30 patients had an excellent result and remaining 9 (30%) had a satisfactory result. All fractures united with a full range of motion at the hip and knee joint without any major complications&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Intramedullary elastic nailing of simple diaphyseal femur fractures in children is an effective method with negligible complications. Treatment cost can be significantly lowered by using the much cheaper stainless steel flexible nails rather than the more expensive titanium nails.&lt;/span&gt;&lt;/p&gt;

Comparison study of compound fractures of tibial shaft treated by titanium and stainless steel interlocking nails

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The purpose of the present study was to compare the outcomes of compound fractures of tibia shaft managed by Solid Titanium and Stainless Steel interlocking intramedullary nailing.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a retrospective study of 45 patients with 45 open fractures of tibia shaft operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In Our Study we had 45 patients with 45 open tibial fractures. All were male. 35 patients were from 20-50 years age group. Mean age was 36.4 years. In this study of 45 open tibial fractures following strict protocol of thorough debridement, primary wound closure and Solid Titanium or stainless steel interlocking nailing; it was observed at final follow up that patients operated by titanium nail compared to stainless steel had 6.45% vs. 14.29% infection rate, 12.9% vs. 21.89% rate of non-union and 3.22% vs. 7.14% screw breakage rate. According to modified ketenjian’s criteria in our study out of 31 patients operated by Titanium interlocking nail 17 (54.84%) excellent, 10 (32.26%) Good, 3(9.68%) fair and 1(3.22%) poor functional results while out of 14 patients managed by stainless steel nail 8 (57.14%) excellent, 3 (21.43%) good, 1 (7.14%) fair and 2 (14.28%) poor functional results. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In open tibial fractures titanium interlocking implants offer lower complication rate as compared to stainless steel implants and better overall patient outcome.&lt;/span&gt;&lt;/p&gt;

Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation.

Rationale:Short double elastic nailing is a minimal invasive, modified ESIN (elastic stable intramedullary nailing) technique for severely displaced distal radial fracture in children. The aim of this technical report is to introduce our new method and evaluate the final results of the procedure.Patient concerns:We reviewed retrospectively 24 patients who underwent short double elastic nailing due to distal radial fractures between November 2012 and December 2015. Indications for surgery included closed, severely displaced, unstable metaphyseal or diametaphyseal fractures of the radius.Intervention:The fractures were stabilized by 2 prebent short elastic titanium nails inserted from the distal side of the fracture. In cases of associated ulnar fracture, a classic anterograd ESIN nailing was also performed. Patients were mobilized immediately in a removable short splint which was removed after 1 to 2 weeks. There has been no additional splinting or casting.Outcomes:There were 17 males and 7 females with an average age of 9.8 years (range, 4–16 years). The right hand was involved in 16 cases and the left hand in 8 cases. The average follow-up was 17.8 months (range, 7–28 months). Of the 24 patients, 3 presented irritation of the skin, which resolved after removal of the radial nail. All the patients regained full range of motion without any complications.Lessons:Our technique is an effective, safe, and easily learnable procedure for unstable fractures of the distal third of the radius. It achieves good functional and radiological results, and allows early mobilization without the need of casting. Avoiding the physeal plates, we reduce the risk of iatrogenic postoperative deformity. Further prospective and biomechanical investigations are necessary to verify our experience.

Quadruple ESIN (Elastic Stable Intramedullary Nailing): Modified Treatment in Pediatric Distal Tibial Fractures.

Nailing of the tibial shaft with 2 Prevot nails is the gold standard for tibial shaft fractures in children. This technical report aims to show a simple way to stabilize pediatric distal tibial fractures without changing of the operation method. A retrospective chart review of all distal tibial fractures treated with the modified elastic stable intramedullary nailing (ESIN) method during a 6-year period was conducted. The modified ESIN technique hardly differs from the classic method, other than the addition of 2 other Prevot nails inserted using the same entry point. Eight children were treated with the modified ESIN. The mean operation duration was 57 minutes (range, 33 to 88 min). In all cases 2 to 4 mm titanium nails were used. None of our patients required a postoperative cast.Within an average of 14.5 days all of the patients could fully bear their weight (2 to 30 d) and full range of motion was reached. The modified ESIN technique achieves good results regarding stability and early weight-bearing. Therefore, this technique could be applied in unstable distal tibial fractures. Nevertheless, a prospective and biomechanical study is needed to verify our experience. Level IV-therapeutic studies.

ESIN and K-wire fixation has similar results in both bone pediatric forearm fractures

The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. The cohort comprised 5 girls and 35 boys whose mean age was 11.60 ± 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures.

Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children

Aims: To determine the clinical profile and clinical, functional, and radiological outcomes and complications in children who underwent elastic stable intramedullary nailing (ESIN) for unstable fractures of both bones of forearm. Materials and Methods: A retrospective observational study was conducted in the Paediatric Orthopaedic Unit of the institution. Children with forearm fractures, who underwent ESIN of both the bones with titanium nails from January 2004 to June 2010, were included in the study. Clinical evaluation for deformity, range of motion at wrist and elbow, Daruwalla’s grading for forearm fractures, and radiological evaluation for bony union, malalignment, and radial bow were done. Paediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to assess functional outcome. Results: Twenty-six patients were followed up for a mean of 2.14 years. These included one primary internal fixation for unstable injury in a 15-year old, 10 open fractures, and 15 with malalignment after closed reduction. Age ranged from 5 to 15 years (mean of 11.39). Average time to bony union was 6 weeks. Twelve children had excellent, 12 good, and two fair outcomes according to Daruwalla’s grade. Average PODCI score was 50.78 (standardized range is minimum of −140 to maximum of 53). There were no major complications related to ESIN. Three patients had paraesthesia over superficial radial nerve distribution, three patients had hypertrophied scars, and one patient had superficial wound infection. One child had distal radial physeal arrest following inadvertent physeal injury during implant removal. Conclusion: ESIN is safe and effective for internal fixation of unstable forearm fractures.