Congenital Pseudarthrosis of Tibia- Treated Using Ilizarov Technique.

The diagnosis of congenital pseudarthrosis of the tibia (CPT) in pediatric age group is difficult (1), particularly if the patient had repeated trauma and was mismanaged.[2,3] The etiology of congenital pseudarthrosis is unknown. Mostly patient presents with neurofibromatosis.[4] Most of cases have defect on anterolateral angulation. Most effective treatment option for CPT is surgery. Surgical methods like Ilizarov technique, intramedullary fixation, and grafting [5] with combination of two or three types surgeries. However, Ilizarov ring fixation is the most effective treatment option. Every surgery should include correction of deformity, bone remodeling, limb lengthening, and complete removal of the lesion. Many patients developed deformity and degenerative arthritis of knee and ankle joints. Unfortunately, operation can’t differ according to the nature of disease history and pathology.[1] As such cases should undergo Ilizarov ring fixation. Most common complication was refracture. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed.

Functional Outcome of Treatment of Fracture Shaft Femur in Children Using Titanium Elastic Nails System.

Fractures of the femur are the most incapacitating fractures. For children aged 6-16 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer preferred. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. We wanted to study the functional outcome following the use of flexible titanium nails for femoral shaft fractures in children and evaluate the duration of union in the above-mentioned fractures. We also wanted to study the complications of fracture shaft femoral after intramedullary nailing.METHODSThirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 6 months to 1 year. The final results were evaluated using Flynn’s criteria. Technical difficulties and complications associated with the procedure were also analysed.RESULTSOverall results were excellent in 28 cases and satisfactory in 02 cases. No patient had poor result. The average hospital stay was 6.47 days. All the fractures healed in 70 days (10 weeks) of times with an average time of union of 60 days (7.5 weeks). The most common complication encountered was soft tissue irritation at the nail entry site seen in 2 cases. Clinically, shortening was noticed in 3 cases, while no patient had lengthening. Malalignment was seen in only 6 cases. There was no iatrogenic bone injury, delayed injury and non-union, bending or breaking of implant, refracture and avascular necrosis of femoral head. There was no evidence of physeal injury on follow up.CONCLUSIONSTitanium elastic nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of good and excellent outcomes in children aged 6-16 years. Technical pitfalls can be eliminated by adhering to the basic principles.

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture   and   rapid   inclusion   of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.