Outcome of shaft fractures among children treated with elastic stable intramedullary nailing

Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes.

Assessment of pain management intervention for treatment of long bone fractures in tertiary care hospital

Background: Musculoskeletal trauma represents a considerable global health burden. Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. So the purpose of the study was to do assessment of pain management intervention, post-op analgesics for treatment of long bone fractures.Methods: All adult patients (more than IS years) reporting to Emergency Medicine Department of a tertiary care hospital with long hone fractures of lower limb were included in the study. Patient pain management was assessed by visual analogue score (VAS). Pain is a complex, subjective personal experience. The assessment of pain is the essential perquisite for successful pain management. It is useful to decide the plan of initial treatment but also to reassess the degree of success. The entire data is statistically analyzed using SPSS software. p-values less than 0.05 are considered to be statistically significant.Results: 74 cases got operated, 64 cases (86.5.0%) did not have any intra-op complications and 10 cases (13.50%) had intra-op complications .Postoperative analgesia the 74 cases operated was as follows: 17 cases (23.0%) epidural anaesthesia 41 Cases (55.4%) had epidural + intravenous analgesics. Recent was managed with 1.V, analgesics alone; 12 cases (16.20%) had tramadol, 2 cases (2.7%) received paracetamol and 2 cases (2.7%) had dynaper for post-operative analgesia.Conclusion: Adequate pain management on arrival in the Emergency Department is an important aspect in patient care and is not at all difficult to achieve. Femoral nerve block in Proximal lower limb fractures is very effective and easy to perform.

External Fixation using Acrylic versus Epoxy as a Connecting bar for Repair of Compound Fracture in Goat

The study was conducted on 10 goats, aged between 10 months to 5 years, brought to T.V.C.C, Jabalpur for the treatment of compound fracture in metacarpal and tibia. The animals were selected irrespective of their age, sex, breed and body weight. The animals were randomly divided into two equal groups. In group I, external skeletal fixation using Acrylic as the connecting bar was applied whereas in group II, Epoxy putty was used as the connecting bar. Wound area at fracture site decreased significantly at 30th day as compared to 0 day. The mean radiographic score increased significantly at 30th day and was highest at 60th day. Weight bearing score improved on 15th day and complete weight bearing was observed on 12th to 30th days in all goats. Pin loosening, pin tract drainage and inflammation were observed post-operatively

Outcomes of long bone fractures treated by open intramedullary nailing at the St Ann's bay hospital, Jamaica / Resultados clínicos de las fracturas de huesos largos tratadas mediante enclavijado intramedular abierto en el hospital de Saint Ann's bay, Jamaica

Between May 2001 to August 2004, 35 patients had open nailing of long bones. There were 40 fractures fixed. Of these 40 fractures, there were 25 femoral fractures, 11 were tibial fractures and 4 were humeral fractures. There were 33 (82.5%) closed fractures and 7 (17.5%) open fractures. In the group of patients with open fractures, there were two Grade I, two Grade II and three Grade IIIB. Seven (20%) patients were lost to follow-up; all of whom had closed fractures. The final analysis as it relates to complications was done using 28 patients with 32 fractures. The majority of fractures healed without significant complication. All the patients with closed fractures went on to bony union. There was one non-union and three delayed unions. There were two infections (osteomyelitis) and this was from the open fracture cohort. This represents an infection rate of 28.6% in this cohort. Two (7.0%) patients had persistent pain and one (3.6%) patient had early removal of the nail because of failure of fixation. The mean time from injury to surgery for the fractured femur was 15.5 (range 0-49) days; fractured tibia 24.4 (range 0-40), days and fractured humerus 41.5 (20-81) days. The mean hospital stay was 18.9 (range 9-37) days for patients with fractured femur; for fractured tibia, it was 20.5 (range 3-82) days and for fractured humerus, it was 22.7 (range 3-82) days. The mean postoperative stay was 4.1 (range 1-14) days for fractured femur, 4.5 (range 1-14) days for fractured tibia and 4.0 (range 1-10) days for fractured humerus. The mean time to healing (consolidation) as defined by X-rays was 5.0 (range 3-11) months for fractured femur, 5.2 ( range 3-11) months for tibia and 7.0 (range 6- 8) months for fractured humerus.

Desde mayo de 2001 hasta agosto de 2004, 35 pacientes recibieron reducción de fracturas de huesos largos mediante enclavijado a cielo abierto. Se produjeron 40 fijaciones de fracturas. De estas 40 fracturas, 25 fracturas fueron del fémur, 11 fueron de la tibia, y 4 del húmero. Hubo 33 (82.5%) fracturas cerradas y 7 (17.5%) fracturas abiertas. En el grupo de pacientes con fracturas abiertas, hubo dos fracturas de grado I, dos de grado II y tres de grado IIIB. El análisis final en cuanto a las complicaciones, se realizó con 28 pacientes con 32 fracturas. La mayoría de las fracturas se curaron sin complicaciones significativas. Todos los pacientes con fracturas cerradas lograron finalmente la unión ósea. Hubo uno que no logró la unión y tres uniones retardadas. Se produjeron dos infecciones (osteomielitis), provenientes de la cohorte de fractura abierta. Esto representa una tasa de infección del 28.6% en dicha cohorte. Dos (7.0%) pacientes presentaban dolores persistentes, y a un (3.6%) paciente le fue retirado el clavo tempranamente debido a que la fijación falló. El tiempo promedio desde la lesión hasta la cirugía, fue de 15.5 días (rango 0-49) para la fractura del fémur; 24.4 días (rango 0-40) para la fractura de la tibia, y 41.5 días (20-81) para la fractura del húmero. La estancia promedio en el hospital fue de 18.9 días (rango 9-37) para los pacientes con el fémur fracturado; para la fractura de la tibia fue de 20.5 días (rango 3-82), y para el húmero fracturado fue 22.7 días (rango 3-82). La estadía postoperatoria promedio fue 4.1 días (rango 1-14) para el fémur fracturado, 4.5 días (rango 1-14) para la tibia fracturada, y 4.0 días (rango 1-10) días para los casos de fractura del húmero. El tiempo promedio de sanación (consolidación) tal como lo definieron los rayos X fue 5.0 meses (rango 3-11) para el fémur fracturado, 5.2 meses (rango 3-11) para la tibia y 7.0 meses (rango 6-8) para el húmero fracturado.

Delayed Operative Treatment of Long Bone Fractures in Patients with Brain Injury

PURPOSE: To evaluate the postoperative progress and outcomes of bone injured patients with long bone fracture showing callus formation and deformity due to delayed surgical treatment. MATERIALS AND METHODS: 10 cases with more than 1 year follow up were chosen from 12 patients with long bone fracture whose surgical treatment was delayed due to brain injury. Exuberant callus formation and deformations were observed. Average delayed period was 6.7 weeks (4~10 weeks). Preoperative callus formation, shortening and angulation were evaluated using plain radiographs. Total operation time and transfusion amount were compared with that from operations done within 2 weeks following accident. Postoperative bone union was checked. RESULTS: In all cases, preformed angulation and hypertrophic ossification made reduction difficult and this increased total operation time and transfusion amount but had no statistical importance. In patients with humerus and femur fractures accompanying brain injury, massive hypertrophic ossification was observed both in preoperative period and in postoperative period. Average bone union period was 13.5 weeks in humerus fractures, 17.9 weeks in femur fractures. The bone union period was shorter in subject group but had no statistical importance. CONCLUSION: Early surgical treatment is essential to patients with long bone fracture accompanying brain injury but if early surgical treatment can not be done, proper immobilization to fracture site should be done.

Three / 대한정형외과학회잡지

Since the finite element method(FEM) was introduced to the orthopaedic biomechanics, it has been applied with increasing intrest to investigate bone, bone-prosthesis, and fracture fixation device, etc., in terms of stress, strain, force, and displacement. The authors implemented the FEM for the "intact" and the "fractured long bone models respectively to observe the mechanical behaviors of the plate fixation for the long bone fractures, and we observed the followings;l. In the intact model, stresses are evenly distributed and smoothly changed. 2. The maximum equivalent von-Mises stress in the fracture model is higher than that in the intact one. 3. Stresses on the plate are much higher than those on the bony surface in the fracture model. 4. Stresses for the bony surface beneath the plate in the fracture model are much lower than those in the intact model;however, stresses are highly concentrated around the screws. 5. Although two-thirds of total compressive load is transmitted through the fracture site area, maximum von-Mises stress in the fracture site is much lower than that in the plate. 6. High stresses are found at the areas between the plate holes and the screw heads. 7. Shearing forces of the screws are higher at the near and end screws from the fracture site.

A Consideration for Metallic Failure of internal Fixation Devices in Treatment of Long Bone Fractres / 대한정형외과학회잡지

The ten cases of metallic failure after I-M nailing & plate fixation who were treated at depart tment of orthopaedic surgery, Soon Chun Hyang University during nine years from June, 1974 to May, 1983 were clinically analysed. The survey as summerized as follows: l. Of the ten cases, six cases were seen the breakage of plate, two cases were the loosening of screw, one case was the brakage of nail & one case was the angulation of nail. Of the six cases of plates, two cases were DCP, three cases were ordinary plate & one case was Thornton plate. 2. Of the six cases who metallic failure occurred as plate failure, five cases were the femur fractures, one case was the tibia fracture. All case who metallic failure occurred as nail failure were ferumr fractures. Of the two cases of screw loosening, one case was the fermur fracture. One case was the tibia fracture. 3. The average interval between operation and metallic failure. 1) The plate breakage was 6.3 months. 2) The screw loosening was 7 months. 3) The nail breakage was 6 months. 4) The nail angulation was 8 months. 4. The causes of failure after internal fixation. 1) The causes of plate breakage.