Early mobilization and reducing hospital stay in children with fracture femur treated by TENS fixation

We retrospectively reviewed 15 cases of diaphyseal femoral fractures treated with close reduction and intramedullary flexible titanium nails, in children aged 3-12 years. The mean follow-up time was 11.5 months [range 3-29]. No cases of nonunion or malunion were noted. We did not observe limb overgrowth of more than 1 cm in any of our patients. Two cases of postoperative angulation were noted, within the accepted limits for that age. In one case the lateral wire was long distally and bending on skin, this child underwent nail removal at 3 months after the initial surgery, without any complications. All the patients demonstrated callus formation on both x-ray views between 3-4 weeks and sound fracture healing between 7-8 weeks. All patients were capable of walking or supporting themselves with partial weight bearing on the injured leg at the end of the first month [range 2-4 weeks], and of walking with minimal support or unsupported at the end of the second month, or even earlier. In our opinion, not only should the final result be considered, but also the burden of the treatment process as a whole. When an alternative mode of treatment permits reduction of this burden without increasing the complication rate, and with similar final results, it is worth considering this option

Early mobilization of elderly patients with intertrochanteric and subtrochanteric fractures fixed by gamma nails

The continuous increase in the number of fractures of the proximal femur is directly attributable to the worldwide increase in life expectancy. The standard version of the Gamma Interlocking-Nail designed because of the demands in orthopedic hip surgery to develop an implant stable enough to mobilize old patients as soon as possible to avoid further morbidity and mortality. Between the years of 2007 and 2008, 26 patients over 60 years with intertrochanteric and subtrochanteric fractures treated by fixation with gamma nails. All the patients were walking normally before fracture. The follow up period ranged from 6 to 18 months. All the patients were mobilized postoperatively on wheel chair second day and full weight bearing 2-6 days with walking frame. Complications included haematoma, wound infection, non union, fracture shaft femur. The treatment of intertrochanteric and subtrochanteric fractures of the femur with the Gamma nail has the theoretic advantages of combining the merits of intramedullary fixation and the sliding screws. Early full weight bearing mobilization which was the aim of this method of fixation was completely achieved in this study