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Introduction: Fractures of shaft of femur are among themost common fractures encountered in orthopaedic practice.The femur is the largest and strongest bone in the bodyarticulating with hip joint proximally forming knee joint withtibia at its distal end. As industrialization and urbanizationare progressing year to year with rapid increase in traffic,incidence of high energy trauma increasing with samespeed. Hence, the aim of the present study was to assess thetreatment of unstable diaphyseal fracture femur with femurintramedullary interlocking nailing.Material and methods: The present study was done among40 patients where skin traction or upper tibial traction forskeletal traction was given with the link supported in a BohlerBraun splint. All routine investigation and surgical fitnesswere asked for intramedullary nailing was chosen for fracturebelow the lesser trochanter and distally fracture within 8 cmfrom the femoral articular surface were chosen.Results: About 60% fractures involved upper 3rd as the site offracture. The pattern of fracture was found to be comminutedwhich was around 35%. The oblique pattern was around32.5% and transverse pattern of fracture was observed to be22.5%.The complications included were implant bending andbreaking, infection,delayed and nonunion,rotational deformityand shortening.Conclusion: Unstable diaphyseal fractures with femurintramedullary interlocking nailing gives excellent result withthis system there are minimal complications which help earlyreturn of patients to activity and work.
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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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A prospective observational study was conducted in Government Victoria Hospital, Visakhapatnam from 2013 to 2018 to evaluate Arogyasri scheme. Arogyasri scheme provides end to end cashless services for identified diseases in Andhra Pradesh. During this period, 891 gynecological surgeries were conducted under this scheme. Out of them, 44 were not approved for claim. A total of 10,880,238 rupees were claimed.
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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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Se realizó un estudio descriptivo, longitudinal y retrospectivo de 123 pacientes con fractura diafisaria de tibia, quienes fueron intervenidos mediante la técnica quirúrgica de fijación con clavo intramedular de Küntscher sin fresado del canal, desde agosto del 2012 hasta diciembre del 2013, en el Hospital Especial de Tumbi, de Kibaha, Tanzania, con vistas a evaluar los resultados de dicho procedimiento. En la serie predominaron el sexo masculino (74,0 %), el grupo etario de 26-35 años (37,4 %), los accidentes de tránsito como causa principal de las lesiones (74,0 %) y la reducción de la fractura de forma abierta (90,2 %); asimismo, 29,4 % de los pacientes presentó complicaciones y 80,5 % mostró buenos resultados en la evaluación final. Finalmente, se pudo concluir que el uso del clavo intramedular de Küntscher sin fresado del canal, es una técnica quirúrgica viable para solucionar las fracturas diafisarias de tibia.
A descriptive, longitudinal and retrospective study of 123 patients with tibial diaphyseal fracture who were surgically treated by means of the surgical technique of fixation with Küntscher intramedullary nail without reaming of channels was carried out from August, 2012 to December, 2013, in Tumbi Special Hospital, Kibaha, Tanzania, with the aim of evaluating the results of this procedure. The male sex (74.0%), the age group 26-35 years (37.4%), the traffic accidents as main cause of the lesions (74.0%) and the reduction of the fracture in an open way (90.2%) prevailed in the series; also, 29.4% of the patients presented complications and 80.5% showed good results in the final evaluation. Finally, it could be concluded that the use of Küntscher intramedullary nail without reaming channels, is a viable surgical technique to solve the tibial diaphyseal fractures.
Subject(s)
Tibial Fractures , Bone Nails , TanzaniaABSTRACT
Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.
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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 compare the clinical effects in patients treated with anterograde reamed intramedullary nail (IMN) and dynamic compression plate (DCP) for diaphyseal fractures of the humerus.Methods Forty-seven patients with diaphyseal fractures of the humerus,were divided into two groups by random digits table:IMN group (23 cases) and DCP group (24 cases),IMN and DCP were performed fixation,respectively.After the surgery,perioperative,functional outcomes of shoulder and elbow,postoperative complications between two groups were compared.Results The average follow-up time was (22.3 ± 5.7)months,3 cases were lost in 12-month-follow-up,1 case in IMN group and 2 cases in DCP group.The operation time,intraoperative blood loss in IMN group were significantly shorter than those in DCP group [(67.7 ± 15.3) min vs.(87.0 ± 12.5) min,(106.3 ±57.6) ml vs.(226.7 ±60.2) ml,P＜0.05].The incidence rate of subacromial impingement in IMN group was significantly higher than that in DCP group [18.2％ (4/22) vs.0,P ＜ 0.05].The incidence rate of wound infection in IMN group was significantly better than that in DCP group [4.5％(1/22) vs.22.7％(5/22),P ＜ 0.05].There were no statistically significant differences between two groups in other indexes (P ＞ 0.05).Conclusions DCP has some advantage in perioperative period,but they are comparable in the functional outcomes of shoulder and elbow and complications.