A prospective study on the functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nailing: A case series of 22 cases (original) (raw)
Related papers
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...
Treatment of Fracture Shaft Femur in Paediatric Age Group with Titanium Elastic Nail
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND In this era of speed, management of fracture of shaft femur in paediatric age group have changed from conservative to operative. This reduced the chance of malunion, rotation and angulation along with allow early mobilisation to minimise the morbidity and complications for the child. In this study, we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur in children treated with titanium elastic intramedullary nail. MATERIALS AND METHODS In this study, 30 patients of 4-14 years' age group with femoral fractures were treated with TENS nail. RESULTS In this study, outcome was assessed by using Flynn's criteria of titanium flexible nail outcome score. Average operative time was 35 minutes. Partial weight bearing started was at 5 weeks and full weight bearing was started at 8 weeks. Most cases 63.4% were having excellent results, 33.3% were having satisfactory results and 3.3% were having poor results. One case was having superficial infection, which was controlled by antibiotic. CONCLUSION TENS nail is having excellent result in fracture shaft femur in paediatric age group with less side effects. So it is surgeon's and patient's friendly implant.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2023
Methods: This was a prospective randomized study comprised 50 patients with displaced diaphyseal femur fractures treated with TEN. Two nails were used in fracture. The patients were followed up at 2 nd week, 1 month, 3 months, and 6 month after surgery. Results were evaluated by flynn's scoring criteria at each follow-up visit. Results: At the end of 6 months, out of 50 patients, excellent result was achieved in 45 patients (90%) and good in five patients (10%). No poor outcome seen. Intramedullary fixation by Tens is an effective treatment of fracture of femur in properly selected patients of the 5-15 years age group. Conclusion: The treatment with femoral shaft fracture in children between the age group of 5-15 years by titanium elastic nail is ideal as it hastens fracture union, reduce rate of mal union, shortening, and allow early rehabilitation.
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.
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.
INTRODUCTION: Fracture shaft femur represents 1.6 percent of bony injuries in paediatric age group. It is one of the common fracture requiring hospitalization and further treatment, either conservative or operative. Many times non operative methods are being preferred considering the financial status of the patient. Other modalities include casting, traction, Thomas knee splint and Pavlik harness. Operative modalities include TENS, Plating and External fixators. Nowadays TENS is one of the preferred modality for such fractures in paediatric age group. AIMS AND OBJECTIVE: To compare the better functional outcome between closed reduction and Internal fixation with TENS and closed reduction and hip spica application in a paediatric age group of 5-12 years with fracture shaft femur. TENS offers early recovery, early mobilization, lower chances of limb length discrepancy. Mainly the child does not need to be bed ridden for long, thus chances of other complications are less. This retrospective study compares the result of the above mentioned two treatment modalities for fracture shaft femur. METHODS: The study includes 38 patients who were available for follow up post surgery /conservative management in Santosh Medical College and Hospital, Ghaziabad from March-2019 to February-2020. We have a study group of 38 paediatric patients with age ranging between 5-12 years, out of which 20 were managed with closed reduction and internal fixation with TENS, and 18 were managed with closed reduction and hip spica application. Patients with proximal or distal femoral fractures closer to the epiphyseal plate, open femoral fractures and patients with pathological fractures were excluded from the study. RESULTS: The group which were treated with closed reduction and internal fixation with TENS were found to be having no deformities, no malunion , no delayed union ,complete functional recovery was achieved. No angulation was found in any of the patient operated and showed up for follow up. The group treated with TENS took a shorter time to start walking with support and then without support. 2 patients out of the group treated with Hip spica were found to have decubitus ulcer which was treated conservatively and 1 patient had more than 10 degrees of mal-alignment .1 patient treated with TENS had post operative superficial suture line infection, which was well controlled with antibiotic therapy. CONCLUSION: Results shows that postoperative time and complications are less in patients treated with TENS and TENS have better results over Hip spica when compared on the basis of functional recovery, hospital stay, early mobilization and less time of care and complications and early return to day to day life. TENS is more preferable than Hip spica in fracture femur shaft in the age group of 5-12 years.
Study of outcome of pediatric shaft of femur fracture treated with Titanium elastic nailing system
Femoral shaft fractures account for 1.6% of all infant skeletal injuries and are incapacitating. The treatment of these fractures is mostly determined by the patient's age, fracture pattern, related traumas, physique, and family's financial situation. We assessed the use of the elastic stable intramedullary nail (ESIN) and its consequences in the surgical therapy of femoral shaft fractures in children. From June 2018 to June 2019, fifty-two youngsters were treated with titanium elastic nails (TEN) at our Janaki Medical College Teaching Hospital, Janakpur, Nepal. At the conclusion of the investigation, 48 children were present. According to Winquest and Hansen's classification, fractures were classified as Grade I (n=32), Grade II (n=10), and Grade III (n=6); compound fractures were classified as Grade I (n=5) and Grade II (n=3). 36 midshaft fractures, 7 proximal third shaft fractures, and 5 distal third shaft fractures were observed. The final results were analyzed clinically using Flynn's criteria and radiologically using the criteria of Anthony et al. The average length of follow-up was 20 months (range 12-40 months). Radiologically, all fractures healed with grade III callus production between 9 and 12 weeks (mean 9.7 weeks). Using Flynn's criteria, the findings were determined to be excellent for 40 children (83%) and satisfactory for 8 children (17%). Nail end-caused soreness in the soft tissues close to the knee was the most common condition in our study (25%). Other problems include limb amputation (n=5), Varus malunion (n=4), infection at the nail protrusion site (n=4), and nail migration (n=2). No delayed union, non-union, or refractures occurred. In appropriately selected youngsters, TEN is a minimally invasive, safe, and relatively simple treatment for fracture shaft of femur.
Role of Closed intramedullary Titanium Elastic Nailing in Fracture Shaft Femur in Children
IP Innovative Publication Pvt. Ltd, 2017
Introduction: Fracture shaft femur is a common injury in children. The best treatment for children between 5 to 14 years of age is still debatable. The ideal device for the treatment of most displaced femoral fractures in children would be a simple, load-sharing internal splint that allows mobilization and maintenance of alignment and extremity length until bridging callus forms. Titanium elastic nails offer these features. Aim and Objectives: To assess the functional and radiological outcome of closed reduction and internal fixation of fractures of shaft femur in children aged 5-14 years with TENS. Materials and Methods: 30 patients were treated from November 2014 to July 2016 between age group of 5-14 years by retrograde TEN fixation. Patients were mobilized without weight bearing on the 7th day post operatively. Partial weight bearing was started at 6 weeks and full weight bearing at 12 weeks depending on the fracture configuration, callus response and associated injuries. Follow up was done at 6 weeks, 12 weeks and 24 weeks. Results: Average radiological union was seen in 12.8 weeks. Maximum patients achieved full range of hip and knee movements. Only two had knee stiffness. Based on Flynn's criteria 70% excellent and 30% good results were recorded. Conclusion: Titanium Elastic Nailing system for the treatment of paediatric shaft femur fractures in the age group of 5-14 years is an effective method, as it avoids any growth disturbance by preserving the epiphyseal growth plate, and avoids bone damage or weakening through the elasticity of the construct.
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.
2014
BACKGROUND Management of femoral diaphyseal fracture in the age group of 5-16 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using titanium elastic nailing system (TENS). MATERIALS AND METHODS Between April 2011 and April 2014, 40 pediatric patients (31 boys, 9 girls) aged 5-16 years with diaphyseal femoral fractures were treated by retrograde TENS fixation. Fractures were classified according to system of Winquest and Hansen as Grade-I (n = 18), Grade-II (n = 10), Grade-III (n = 7) and compound fractures according to the Gustilo and Anderson's classification Grade-I (n = 3), Grade-II (n = 2). The final results were evaluated by using Flynn's criteria. RESULTS The mean duration of follow-up was 21 months (range 3-39 months). All fractures were radiologically united with grade 3 callus formation at 8-10 weeks period (mean 9 weeks) and full weight bearing was possible in a mean time...