Prospective study of management of long bone fracture by intra-medullary elastic nailing in children
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20200738Keywords:
Paediatric fractures, TENS nail, Long bone fracturesAbstract
Background: The treatment of long bone fractures in children from 6 to 14 years is a challenging scenario. Titanium elastic nail (TEN) fixation was originally meant as a gold standard treatment method for femoral fractures, but was gradually applied to other long bone fractures in children, because it represents a middle path between conservative and surgical modality.
Methods: In the present study paediatric patients in the age group of 6 to 14 year with long bone fractures to be treated with TEN in the Department of Orthopaedics were admitted to MGM Hospital (Kamothe) were selected. A total of 30 patients consenting to undergo this study were subjected for treatment after screening using the inclusion and exclusion criteria.
Results: The mean age of the patients was 9.67±2.68 years. There was male preponderance (63.3%). In our study, RTA was observed to be the main cause of fracture (80%) whereas 20% fractures were due to fall. In our study, 50% patients had fracture of radius ulna followed by fracture of tibia 23.3%, femur (23.3%), and humerus (3.3%). The mean time to union was 5.30±1.06 weeks.
Conclusions: TEN seems to be simple, biocompatible, more physiological, reliable and effective method of treatment of all long bone shaft fractures in 6 to 14 years old children. It is a rapid, safe and simple procedure with advantages of short operative time, minimal blood loss, shorter hospital stays early union, allowing early mobilization and early return to function with minimal complications.
Metrics
References
Scheidt PC, Harel Y, Trumble AC, Jones DH, Overpeck MD, Bijur PE. The epidemiology of nonfatal injuries among US children and youth. Am J Public Health. 1995;85(7):932-8.
Walsh SS, Jarvis SN, Towner EM, Aynsley-Green A. Annual incidence of unintentional injury among 54,000 children. Inj Prev. 1996;2(1):16-20.
Landin LA. Epidemiology of children’s fractures. J Pediatr Orthop B. 1997;6(2):79-83.
Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res. 2004;19(12):1976-81.
Rivara FP, Calonge N, Thompson RS. Population-based study of unintentional injury incidence and impact during childhood. Am J Public Health. 1989;79(8):990-4.
Kopjar B, Wickizer TM. Fractures among children: incidence and impact on daily activities. Inj Prev. 1998;4(3):194-7.
Valerio G, Galle F, Mancusi C, Di Onofrio V, Colapietro M, Guida P, et al. Pattern of fractures across pediatric age groups: analysis of individual and lifestyle factors. BMC Public Health. 2010;10:656-710.
Slongo TF, Audige L, Group AOPC. Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma. 2007;21(10 Suppl):S135-60.
Audige L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma. 2005;19(6):401-6.
Slongo T, Audige L, Clavert JM, Lutz N, Frick S, Hunter J. The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop. 2007;27(2):171-80.
Slongo T, Audige L, Schlickewei W Clavert JM, Hunter J, International Association for Pediatric Traumatology. Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J Pediatr Orthop. 2006;26(1):43-9.
AO Comprehensive Injury Automatic Classifier (AOCOIAC). Available at: https://www.ao-foundation.org/Structure/resource/AO-OTA-Fracture-Dislocation-Classification/comprehensive-injury-automatic-classifier/Pages/Comprehensive-Injury-Automatic-Classifier.aspx. Accessed on 3 November 2019.
Mathison DJ, Agrawal D. An update on the epidemiology of pediatric fractures. Pediatr Emerg Care. 2010;26(8):594-603.
Brudvik C, Hove LM. Childhood fractures in Bergen, Norway: identifying high-risk groups and activities. J Pediatr Orthop. 2003;23(5):629-34.
Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16(6):500-13.
Hedstrom EM, Svensson O, Bergstrom U, Michno P. Epidemiology of fractures in children and adolescents. Acta Orthop. 2010;81(1):148-53.
Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. 2007;38(8):913-22.
Schalamon J, Dampf S, Singer G, Ainoedhofer H, Petnehazy T, Hoellwarth ME, et al. Evaluation of fractures in children and adolescents in a Level I Trauma Center in Austria. J Trauma. 2011;71(2):E19-25.
Dimitri P, Bishop N, Walsh JS, Eastell R. Obesity is a risk factor for fracture in children but is protective against fracture in adults:a paradox. Bone. 2012;50(2):457-66.
Dimitri P, Wales JK, Bishop N. Fat and bone in children:differential effects of obesity on bone size and mass according to fracture history. J Bone Miner Res. 2010;25(3):527-36.
Goulding A, Jones IE, Taylor RW, Piggot JM, Taylor D. Dynamic and static tests of balance and postural sway in boys:effects of previous wrist bone fractures and high adiposity. Gait Posture. 2003;17(2):136-41.
de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257-64.
Barry M, Paterson JMH. Flexible intramedullary nails for fractures in children, J Bone Joint Surg Br 2004;86:947-53.
Linhart WE, Roposch A. Elastic stable intramedullary nailing for unstable femoral fractures in children:preliminary results of a new method. J Trauma. 1999;47(2):372-8.
Gonzalez HP, Burgos FJ, Rapariz JM. Intramedullary nailing of the femur in children, Effects on its proximal end. J Bone Joint Surg Br. 1995;77(2):262-266.
Thometz JG, Lamdan R. Osteonecrosis of the Femoral Head after Intramedullary Nailing of a Fracture of the Femoral Shaft in an Adolescent. J Bone Joint Surg Am. 1995;77(9):1423-6.
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4-8.
Sankar WN, Jones KJ, Horn BD, Wells L. Titanium elastic nails for pediatric shaft fractures. J Child Orthop. 2007;1(5):281-6.
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for paediatric femur fractures:A multi-center study of early results with analysis of complications. J Pediatr Orthop. 2001;21:4-8.
Flynn JC, Mathews JG, Benoit RL. Blind pinning of displaced supracondylar Fractures of the humerus in children :Sixteen years experience with long term follow up. J Bone Joint Surg Am. 1974;56:263-72.