Comparative study about the functional outcome of Closed reduction and Internal fixation with TENS and closed reduction and Hip Spica application in paediatric shaft femur fracture within age Of 5 -12 years (original) (raw)
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National Journal of Clinical Orthopaedics, 2019
Introduction: Shaft of femur fracture are one of the most common diaphyseal fractures in children with an incidence of about 19/1 lakh population. The aim of treatment is mainly anatomical reduction and realignment with proper functioning of hip and knee joints. TENS is now the preferred treatment of choice because it involves the insertion of two or three titanium nails. Aim of Study: The aim of this study was to assess functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nail. Materials and Methods: The study has been conducted in Department of Orthopaedic, K.R. Hospital December 2017 and December 2018. Patients underwent operative treatment on table with manual traction. After proper reduction of fracture, small skin incision was given on either side of distal thigh around 2 cm proximal to distal epiphyseal plate. Titanium elastic nail of the correct size with curve ends were introduced from both medial and lateral side simultaneously till fracture site after it one nail was passed across the already reduced fracture site followed by another one. Postoperatively patients were encouraged quadriceps strengthening and knee bending exercises as soon as patients could tolerate (Usually within 24 hours of surgery) and for few days, patients were kept non-weight bearing following which partial weight bearing allowed depending on the stability of fracture and callus formation but full weight bearing was allowed only after radiological evidence of firm union. Results: Total 22 patients with shaft femur fracture were operated between December 2017 and 2018 with TENS nail in the Department of Orthopaedics K.R Hospital. There were 15 boys and 7 girls aged between 5-15 years who were taken. Most of the cases were due to RTA (54%) and self-fall accounted for 46%. Out of the fractures, proximal accounted for 9%, mid-shaft fractures 68% and remaining were distal. The most common side affected in our case series was right which was in 17 kids (77%). Out of all types of fractures, transverse accounted for 31%, spiral 22% and the remaining were oblique. Closed reduction and internal fixation was done with negligible blood loss. Our patients underwent an average stay of 5 days in the hospital with minimum of 2 days and maximum of 8 days. Union in our study was achieved at an average of 9.2 weeks and cases were followed up at 2, 6, 12, 16 weeks. Conclusion: TENS is a good method of choice for paediatric fracture shaft of femur fractures particularly in the age of group of 5-15 years of age as it acts an internal splint without disturbing periosteum, promotes faster bridging and callus formation and finally early mobilization.
International Journal of Orthopaedics Sciences
TENS (Titanium Elastic nailing system has become the standard treatment for pediatric femoral shaft fractures in the age group 6-14 years. The other treatment options are traction plus spica casting and external fixation. In spite of excellent results described in various studies, there still exists disunity in the orthopedic fraternity with regards to its usefulness. The aim of this study is to determine the outcome of pediatric femur fractures treated with TENS nailing. Between September 2020 and November 2022, 25 children within the age group of 3-12 years with femoral shaft fractures were included in the study. Two TENS nails of precalculated size were inserted in a retrograde fashion under fluoroscopic guidance. Patients were followed up at regular intervals to assess clinical and radiological parameters. Final results were evaluated using Flynn's clinical criteria. Results: There were 14 males and 11 females with an average age of 6.8years. Fracture levels included N=6 subjects (24%) proximal third fractures. N=15 (60%) subjects with Middle third fractures. N=4 (16%) subjects presented with Lower third fractures. Open injuries were present in 6 cases and 19 cases with closed injuries. The mean injury to surgery interval was 2.37 days, mean hospital stay was 7.3 days and mean time to union was 8.16 weeks. Severe complications were severe skin irritation with bursitis requiring early nail removal in one case, delayed union in one case, Results were excellent in 13(52%) patients, satisfactory in 10 (40%) patients and poor in 2(8%) patients. Conclusion: TENS is safe, reliable and an effeciant method of fixation owing to its simplicity, minimal invasiveness, ease of insertion and removal, TENS additionally has better cosmesis, rapid union with short rehabilitation, less psychosocial stress to the patient and family.
International Journal of Research in Orthopaedics, 2016
Femoral-shaft fractures are among the most common fractures of the lower extremity in children, with an annual incidence of up to 1 per 5,000. 1,2 There are several different options for treating femoral-shaft fractures in children, including skeletal or skin traction, early or immediate application of a hip spica cast, pontoon spica, closed reduction and minimally invasive plate osteosynthesis, external fixation, plate fixation, and internal fixation with the insertion of intramedullary nails. 3,4 Selecting the management strategy is dependent on factors such as the presence of other associated injuries or multiple trauma, fracture properties, age, and socioeconomic factors. Because of its clinical effectiveness and low rate of complications, elastic stable intramedullary nailing for fractures of long bones in the skeletally immature patient (e.g. children) has gained widespread popularity. Titanium elastic nailing (TEN) is commonly used to stabilize femoral fractures in schoolaged children, We tried to compare the end results of both modalities of the treatment of diaphyseal fracture femur and found the operative treatment stands far superior to age old traditional cast treatment. METHODS Prospective study was conducted from March 2014 to February 2015. Children with closed femoral shaft fracture, age ranging between 6 to 16 year were included ABSTRACT Background: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children. Methods: Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters. Results: All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union. Conclusions: Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment.
Tens versus Plate Fixation Pediatric Femoral Shaft Fracture. A Randomised Control Trial Study
Acta Scientific Orthopaedics, 2022
Background: Femur fractures are one of the most prevalent injuries in children. Femoral shaft fractures are the most common orthopedic injury that requires hospitalization, accounting for around 1.6 percent of all bone injuries in children. Treatment for femoral shaft fractures in children is determined by the patient's age and weight, as well as the type of fracture. Traction and hip Spica were the usual treatments for all femoral shaft fractures that needed a lengthy stay in the hospital until recently. However, in recent decades there has been a shift toward increased use of surgery such as intramedullary nailing and plate fixation because of decrease impairment, increase convenience and decrease cost of care. There are increasing reports in literature that operative treatment more satisfactory results than non-operative but the treatment of choice in children are still controversial. Aims and Objective: To compare the functional outcome in patients who underwent surgery for the femoral shaft fracture using the titanium elastic nail and the plate fixation. Methods: This is prospective and comparative study was carried out in the department of orthopedic surgery, unit IV and V Taihe Hospital affiliated to Hubei University of Medicine, Shiyan, Hubei, China from April 2018 to February 2019. A total of 20 patients were enrolled in this study and divided equally into 2 groups TENS and plate 10 patients on each group. Results: Out of 20 patients10 (50%) patients treated with TENS and 10 (50%) were treated with plates. Mean age of total patients was 6.65 ± 2.110 years. road traffic accident is the main cause of injury in both group which comprises 5 (50%) patients in TENS group and 4 (40%) patients in plate group. Majority of the factures were in the middle third of the femoral shaft. The mean blood loss in TENS group was 16 ± 6.146 ml while in plates group 160 ± 45.947 ml. which shows significant between two groups with (p = 0.00 < 0.005). The average operating time in TENS group was found to be 54 ± 14.298 minute while in case of plaiting group was 127 ± 22.998 minute with (p = 0.000 < 0.05). Average time of union in TENS group was 8.10 ± 2.846 weeks and in plate group was 9.80 ± 1.989 weeks. Which is insignificant with (p = 0.139 > 0.05). among total 17 (85%) patients had no complications, Superficial infection found in 2 (10%) patients with plates group. and delayed union was found in 1 (5%) patient in with TENS group with (p = 0.217 > 0.05). There is no significance difference found with respect to complication between both groups. The final outcome assessed by Flynn's criteria, showed that 14 {7 (70%) were from TENS group and 7 (70%) from plate group} had excellent results. 6{3 (30%) from TENS group 3 (30%) from plate group} had satisfactory and None of them have poor result in both group. These differences were not found to be statistically significant (p = 1.000 > 0.05).
50 cases of fracture shaft of femur were managed by closed reduction with TENS at post graduate department of orthopaedics G.M.C Jammu between July 2013 to July 2015 Out of 50 cases 36 (72%) cases were male and 14(28%) female. These fractures were common in the age group between 9 to 12 years accounting for 26 cases (52%) who were involved in outdoor activities, sports and hence more prone to trauma. Right limb (60%) was more involved than left limb (40%), Road traffic accidents (80%) was the major cause of fracture shaft of femur followed by fall from height (20%), Middle third (76%) of shaft was mostly fractured followed by proximal third (20%) then lower third (4%), transverse fracture was the most common pattern of fracture (60%) followed by short oblique (24%) and short spiral type(16%). No patient develop superficial or deep infection at the surgical site.Total period of union took from 8 to 10 weeks, average time of union was 9weeks. It was also seen that 6 patients (12%) had limb length discrepancy of less than 2cm and 4 patients (8%) had angulation of less than 5 degrees and 6 patients (12%) had knee stiffness after TENS. Overall results based on Flynn et al criteria was excellent in 48 cases (96%) and good in 2 case (4%).
Prospective study of tens in femoral diaphyseal fractures among paediatric age group
International Journal of Orthopaedics Sciences
Femoral diaphyseal fractures account for <2% of fractures among paediatric age group. However, with advancement in the field of orthopaedics, surgeons are interested in a better and more stable fixation of these fractures which were treated conservatively. The primary aim of this study is to analyse the efficacy of titanium elastic nailing in femoral diaphyseal fractures. The study was done between June 2017 to May 2018. Two titanium nails are used under the C-arm guidance for stable fixation of fracture. Follow up of minimum 4 months is carried out in this study. In this prospective study, a total of 33 cases were selected. 21(63.6%) male and 12(36.3%) female patients with average age group of 9.81years. All 33 patients with femoral diaphyseal fractures were treated with 2 titanium nails. Post operatively patients were admitted in hospital for 5 days where they were treated with analgesics and i.v antibiotics for a period of 3 days and supportive medications for next 2 days. Fracture union was identified in routine X rays at an average duration of 6.72 weeks among the operative cases. Post-operative radiographs were examined for any varus or valgus angulation, non-union, delayed union and mal-union. Patients were advised not to weight bear on the fractured limb for a duration of 8 weeks. Partial weight bearing was instructed at the end of 8 weeks and full weight bearing at the end of 10 weeks.
2016
Introduction: Trauma is a leading cause of morbidity and mortality in children after acute infection. Among which paediatric femoral shaft fracture accounts 1.6% of all paediatrics bony injury. There is little controversy regarding treatment of femoral shaft fracture in infants and toddlers using Spica casting and femoral shaft fracture in adolescent using rigid antegrade intramedullary nail. The purpose of the study is to evaluate functional and radiological outcome following fixation of paediatric femoral shaft fracture in age group 5 to 16 years using titanium elastic nail system. Material and Methods: 32 patients with 35 femoral shaft fracture with 3 cases of bilateral femoral shaft fracture included in the study. The cases included were of both sexes with mean age 8.4 years. All cases were closed and fresh fracture with mean duration between trauma and surgery was 2.62 days. All cases were treated with two Titanium elastic nail. Follow up of cases done at regular interval 6th w...
Integrative Journal of Medical Sciences
Background- Diaphyseal femur fracture in paediatric age group are common in orthopaedics with treatment options varying from conservative methods such as hip spica to operative measures such as nailing/plating. We analyzed results of patients treated conservatively in a hip spica cast. Material and Methods- 58 patients, upto 5 years of age, with shaft femur fracture managed by hip spica cast were retrospectively analysed in terms of healing clinically and radiologically and complications noted, if any. Results- Fracture healed satisfactorily in all patients. Mean age of patients affected was 3.8 years. Males were more affected and road side accident was most common etiology. Mean hospital stay was 3.4 days. Most common complication was skin breakage (27.58%) followed by cast soiling or breakage (13.79%) while shortening was seen in 3 patients (5.1%) and angulation in 2 patients (3.44%). Conclusion- Despite newer and safer implants, hip spica remains safe and cost effective method fo...
Femoral fractures are among common injuries in the paediatric age group treated by an orthopaedic surgeon. In the last two decades there was an increased interest in the operative treatment of paediatric fractures. Controversy persists regarding the age between 0 to 12 years 3 So we performed a study to find out whether conservative management is justified in paediatric patients with femoral shaft fractures or not. This was a prospective interventional study in which all children between 0-12 years of age with diaphyseal fractures of femur admitted in department of orthopaedics, RIMS hospital, Imphal-were included in the study. The study was conducted from September 2014 to August 2016. The aim of our study was to evaluate the functional outcome after traction and hip spica application in diaphyseal femoral fractures between 0 to 12 years. In our study a total of 30 cases were included and the final outcome was excellent in 20 cases, satisfactory in 9 cases and there was one patient had poor outcome.
Paediatric femoral fractures treated by hip spica- Result of 42 patients
Hong Kong Journal of Orthopaedic Research, 2020
Background- For diaphyseal femur fracture, treatment options varies from conservative as hip spica or operative as nailing/plating.We analysed results of patients treated conservatively in a hip spica cast. Material and Methods- 42 patients, upto 5 years of age, with shaft femur fracture managed by hip spica cast were retrospectively analysed in terms of healing clinically and radiologically and complications, if any. Results- Fracture healed satisfactorily in all patients. Males were more affected and road side accident was most common etiology. Mean hospital stay was 3.5 days. Most common complication was skin breakage (33.3%) followed by cast soiling or breakage (14.3%) while shortening was seen in 2 patients and angulation in one patient. Conclusion- Despite newer and safer implants, hip spica remains safe and cost effective method for treatment of femur fracture in children.