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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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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 .
ABSTRACT
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.