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OBJECTIVE@#To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch.@*METHODS@#The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D'Aubigne Postel score system at last follow-up.@*RESULTS@#Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group ( P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant ( P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups ( P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups ( P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D'Aubigne Postel scoring system between the two groups was not significant ( P>0.05).@*CONCLUSION@#TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.
Subject(s)
Humans , Titanium , Fracture Fixation, Internal/methods , Blood Loss, Surgical , Retrospective Studies , Bone Screws , Treatment Outcome , Fractures, Bone/surgery , Spinal Fractures , Hip FracturesABSTRACT
Aims and objectives: To study the functional outcome of TENS in Pediatric shaft radiusulna fracture.Introduction: Symmetrical bracing action of elastic nails inserted into the metaphysis, thatbears against the inner bone at three points is the principal of the titanium elastic nailing.Early stability to the involved bone fragments is the benefit of this method and it permitsearly mobilization and returns to the normal activities of the patients, with very lowcomplication rate.Materials and methods: A retrospective study of 40 pediatric patients with closed and opengrade 1 shaft radius-ulna fracture carried out at our institute between 2018-2019 treated withTENS and observed for a period of minimum 1.5 years.Conclusion : It can be concluded that TENS nailing in pediatric shaft radius-ulna fractures isan excellent modality of treatment and has very low complication rate.
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Background: Clavicle fracture is one of the most common fractures of young active individuals; most of the clavicle fracturesare managed by the conservative method previously, but after understanding the fracture, biomechanics of clavicle surgicalmanagement found to have a good functional outcome and early mobilization of the patient. Fracture pattern-like displacedcomminuted, shortening <2 cm all have an impact on union and functional outcome.Methods: This is a prospective study of 40 cases of the clavicle fracture treated by ORIF with locking compression plate andclosed reduction internal fixation/open reduction internal fixation (ORIF) with an elastic nail. The period of study follow-up extendsfrom 2017 to 2019 in the Department of Orthopedics, KAPV Medical College Hospital, Tiruchirapalli.Results: In our study, we evaluated 40 cases of clavicle fracture treated by ORIF with locking plate (20 cases) and titaniumelastic nailing (20 cases). All the 20 cases of plating, two cases had a superficial infection and treated by higher antibioticsand one case after fracture healing implant exit done. The infection was settled. All the 20 cases of nailing, 18 cases are goodoutcome, one case are non-union, and two cases were superficial infection after higher antibiotics infection was settled.Conclusion: Locking compression plate is recommended for displaced midshaft comminuted clavicle fracture. When comparedto elastic nailing, locking compression plate has an excellent functional outcome and minimal complication.
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Purpose: To demonstrate the effectiveness of intramedullaryfixation of displaced long bones shaft fractures in skeletallyimmature children using the elastic stable intramedullary nails.Patients and Methods: The case records of 20 children whounderwent fixation with titanium intramedulary nails because oflong bones fractures were reviewed. There were 2 humeral, 3forearm, 10 femoral and 5 tibial fractures. The average age ofthe patients was 11 years, and they were followed-upto 20months. Subjective satisfaction was assessed.Results: All patients achieved complete healing at a mean of7.5 weeks. Complications observed in patients were: oneneuropraxia, six entry site skin irritations, two protrusions of thewires through the skin and two skin infections at the entry site.In a subjective measure of outcome at follow-up, 89% ofpatients were very satisfied while 11% were satisfied. Therewas no report of patient’s unsatisfaction. The implants wereremoved at a median time of six months from the indexoperation.Conclusion: Elastic Stable Intra-medullary Nailing isthe method of choice for the pediatric patients, because it isminimally invasive and shows very good functional andcosmetic results. It allows an early functional and cast-freefollow-up with a quick pain reduction.
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Background: There is a little disagreement concerning the treatment of long bone fractures in children less than 6 years ( plaster of paris cast) and adolescents older than 16 years (locked intramedullary nailing). Controversy persists regarding the age between 6 to 16 years, with several available options. Whatever the method of treatment, the goals should be to stabilize the fracture, to control length and alignment, to promote bone healing, and to minimize the morbidity and complications for the child and his/her family. The objective of this prospective clinical study was to evaluate the results of operative treatment of pediatric long bone fractures in the age group between 5 to 16 years using titanium elastic nailing system (TENS) nails. Methods: All children and adolescent patients between 5-16 years of age with diaphyseal fractures of long bones were admitted at Mamatha general and superspeciality hospital, Khammam. Meeting the inclusion and the exclusion criteria during the study period were the subjects for the study. Totally, 30 cases were studied without any sampling procedure. Patients were followed up at 6, 12 and 24 weeks after surgery and assessed clinically and radiologically. The final outcome is assessed as per Flynn’s criteria as excellent/ satisfactory/poor. Results: The final outcome was excellent in 22 (73.33%) cases, satisfactory in 8 (26.67%) cases and there were no poor outcome cases. Conclusion:Titanium elastic nail fixation is a simple, easy, rapid, reliable, excellent and effective method for management of pediatric long bone fractures between the age of 5 to 16 years, with shorter operative time, lesser blood less, lesser radiation exposure, shorter hospital stay, and reasonable time to bone healing.
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<p><b>PURPOSE</b>The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique.</p><p><b>METHODS</b>Thirty patients with isolated Judet III and IV fractures were included in this prospective study. Judet I and II fractures and radial neck fractures associated with other injuries were excluded. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow Score.</p><p><b>RESULTS</b>The functional result was good to excellent in 24 of 30 cases (80%). The mean Oxford Elbow Score was 44.32. The mean follow-up was 40.11 months. The complications seen were radiocapitellar joint penetration - 6 cases at mean 4.87 weeks, redisplacement - 6, radial epiphyseal sclerosis - 5, and heterotopic ossification - 1 case.</p><p><b>CONCLUSION</b>Intramedullary K wires may result in radiocapitellar joint penetration. Titanium Elastic Nail System should not be used as purely fixation devices as they may not prevent redisplacement. Regular follow-up until at least 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be given a guarded prognosis. The paper highlights the pitfalls of the technique and makes recommendations regarding the type of implant, follow-up and patient counselling in Judet IV fractures.</p>
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Introduction: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed antegrade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. Materials and Methods: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. Results: Twenty-five (100%) fractures united with an average consolidation time of 14.98 weeks (10-32 weeks), and no fractures ended in non-union. Nail impingement was seen in two (8%), shoulder stiffness in one (4%). Functional results were excellent in 22 (88%), moderate in two (8%) and poor in one (4%). There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years). The average duration of hospital stay was 3.84±2.30 days. Conclusion: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.
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Background: Skeletal trauma accounts for 10-15% of all childhood injuries. The increasing incidence of fractures in children mainly attributed to increased road traffi c accidents and sports participation. Materials and Methods: The study was conducted from October 2012 to April 2015 at Terna Medical College, Navi Mumbai. A 28 pediatric patients (20 male and 8 female), who came to emergency department with long bone fractures subsequently, underwent surgical fi xation of long bones by titanium elastic nailing (TENS) were included in this prospective study. Results: Road traffi c accident was the main mode of injuries. The most common long bone fracture was femur 40% and 60% tibia fracture. Pattern of fracture 33.3% transverse, 13.3% commiunited, 20% oblique, 26.7% spira, 6.7% segmental. The level of fracture 80% middle third. The time interval between trauma and surgery was average 3.65 days. Average duration in 50.20 min. Average duration of immobilization is 7.2 weeks. Duration of stay in hospital was 10.25 days. Time of union is 10.35 weeks. Time of weight bearing in the present study is 11.8 weeks. Follow-up done for period of 24 weeks. According to Flynn’s criteria, 89% of patients were excellent and 11% satisfi ed; no patients reported their outcome as not satisfi ed. Conclusion: TENS is the method of choice for the management of long bone fractures in children, because its elastic mobility promoting rapid union at fractures site, stability ideal for early mobilization. It gives lower complication rate, good outcome. It allows an early functional and cast-free follow-up, quick pain reduction compared plating technique including a minimally invasive technique. A less time-consuming procedure and easier metal work removal, cosmetically a small scar. Our study results provide new evidence that expands the inclusion criteria for this treatment and shows that TENS can be successfully used regardless of fracture location and fracture pattern.
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Objective To investigate the effect of intramedullary stabilization of tibiofibular fractures with titanium elastic nails (TENs) in children .Methods Totally 59 children patients with tibiofibular fractures ,from January 2008 to November 2013 ,were stabilized with TENs in the C‐arm fluoroscopy in our hospital .All patients were followed up after surgery ,including fracture heal‐ing ,wound conditions ,limb length ,range of motion of knee and ankle ,gait ,etc .Results All of the 59 cases were followed up for 6-36 months ,average 16 months .All fractures were healed in good alignment .There were no postoperative complications such as infections ,swelling and pain at the end of the nails ,TENs broken ,tibial epiphysis injuries and unnormal function of the lower limb joint .According to the Flynn evaluation standard ,excellent result were observed in 49 cases ,good in 10 cases ,the excellent and good rate was 100% .Conclusion Intramedullary stabilization with TENs can achieve effective fixation in the treatment of tibiofibular fractures ,it has advantages of micro‐trauma ,tiny tissue damage ,little influence on blood circulation at the fracture site ,good stabili‐ty ,rapid healing ,short hospital stay and few complications .
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Objective To analyze the stress distribution and peak stress on midshaft clavicular fractures fixed by titanium elastic nail (TEN) or reconstruction plate, respectively. Methods CT data of the clavicle was adopted to reconstruct the intact clavicle model and the midshaft clavicular fracture models with the TEN and reconstruction plate fixation by using Mimics software. All the three dimensional finite element models were analyzed using Abaqus 6.9 software. The distal displacement, the peak stress and stress distribution on the distal clavicle under the axial load (250 N) and vertical load (250 N) were calculated for the three models. Results The axial displacement of the distal clavicle under the axial load showed TEN (0.23 mm)>intact clavicle (0.14 mm)>reconstruction plate (0.11 mm), respectively. While the vertical displacement of the distal clavicle under the vertical load was 5.12 mm for TEN, 3.71 mm for intact clavicle and 2.25 mm for reconstruction plate, respectively. But the peak stress of the clavicle under the axial load was 33.1 MPa for TEN, 18.7 MPa for reconstruction plate, and 15.5 MPa for intact clavicle model, respectively. And the peak stress under the vertical load was 146.3, 64.1, 56.1 MPa in the TEN, intact clavicle model, and reconstruction plate model, respectively. The stress distribution in TEN model under both kinds of loads was similar to that in intact clavicle model, while under the vertical load, the stress distribution in reconstruction plate model was clearly different with that in intact clavicle model. For the implants under the axial load, the peak stresses were 191.5, 52.3 MPa in the TEN model and reconstruction plate model, respectively, and the peak stress on implants under the vertical load was 1 248.0, 421.7 MPa in the TEN model and reconstruction plate model, respectively. Conclusions The TEN for treating midshaft clavicular fractures showed a stress distribution similar to the intact clavicle, with a higher peak stress and a higher peak implant stress at the fracture site. The reconstruction plate fixation for midshaft clavicular fractures was shown to be more stable, but with obvious stress shielding. Therefore, TEN is generally preferable for treating the simple displaced fractures of midshaft clavicle. However, the ipsilateral shoulder should avoid excessive exercise and weight bearing in the early postoperative period.
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Objective To investigate the effect of intramedullary stabilization of lower limb fractures with titanium elastic nails (TENs) in children.Methods From June 2004 to October 2010,278 children were stabilized with TENs in our hospital,including 181 boys and 97 girlsat average age of 7.6 years (range,3.0-14 years).There were 162 patients with femoral fractures,of which 35 underwent open reduction and the rest closed reduction.There were 116 patients with tibial fractures,which was treated with closed reduction.Postoperative fixation lasted for 3-4 weeks.The mean hospital stay was seven days.Of all the patients,272 patients received the removal of the TENs six months after operation and 242 received more than one year of follow-up to have a further observation on the limb length,hip and knee mobility and gait condition in children.Results All the patients were followed up for 6-66 months (mean,33 months).All fractures were healed in good alignment without severe complications.There were no intraoperative complications like infections,delayed union,nonunion,TEN broken and femoral or tibial epiphysis injuries.Ten patients suffered from swell and skin irritation in the nail' s position 3-4 months after operation,and the nails were removed in advance.Nineteen patients showed unequal lengths ( within 1 cm) of the lower limbs,with normal function of the lower limb joint but with no obvious limp.According to the Flynn evaluation standard,the excellent and good rate was 100％.Conclusions Characterized by good stability,rapid healing,small incision,anatomic reduction,unimpaired periosteum,short hospital stay and few complications,intramedullary stabilization with titanium elastic nails can achieve effective fixation in the treatment of lower limb fractures in children.
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Objective To evaluate the treatment methods for subtrochanteric femur fractures in children and adolescents.Methods Sixty-two patients (at age of 4-16 years) with subtrochanteric fe-mur fractures were managed with traction and delayed hip spica (14 patients, set as nonoperative group) ,titanium elastic nails or pin combined with cast (38 patients, set as less invasive group) and plates (10 patients, set as traditional operative group).The radiologic outcomes, hip joint function and complica-tions of the patients were analyzed.Results According to Beaty scoring, five patients in nonoperative group and 44 in operative group obtained satisfactory early radiologic outcomes.Late radiologic outcome was satisfactory in nine patients from nonoperative group and 46 from operative group according to Theolo-gis scoring, with statistical differences between two groups (P<0.05).Sanders scoring showed excellent results in 11 patients and good in three from nonoperative group, and excellent results in 43 and good in five from operative group, with no statistical differences between two groups (P > 0.05).Less invasive group and traditional operative group showed significantly statistical different in aspects of complications and Sanders scores (P < 0.05).Conclusions Operative treatment provides more satisfactory early and late radiologic results than nonoperative methods.Less invasive operations have better outcomes than tra-ditional operative methods.Selection of treatment modalities based on age, body weight, fracture features and soft tissue conditions of children is the prerequisite for a good outcome.