Functional Outcome in Paediatric Shaft of Femur Fractures using Flexible Intramedullary Nailing

Vimal Raj, C S (2020) Functional Outcome in Paediatric Shaft of Femur Fractures using Flexible Intramedullary Nailing. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: In paediatric age group femur shaft fractures represents 1.6% of all bony injuries in children more common in boys . It occurs as a bimodal distribution with age groups peaking in toddlers (simple falls) and young adolescence (high energy trauma). With most of the femur fractures managed conservatively in early days create substantial disability and deformity. Over the last two decades there has been a tremendous rise towards operative stabilization of paediatric diaphyseal fractures. Due to the evolution of orthopaedics, especially in orthopaedic understanding of biomechanics, variety and quality of implants, principles of internal fixation, antibiotics and asepsis have all contributed tremendous change in the treatment of pediatric fractures. Conservative treatment in treatment of femur fractures led to problems like angular deformity, knee stiffness, delayed union, nonunion. Open reduction and internal fixation has been advocated using various implants including flexible intramedullary nails (12), submuscular plane fixation, intramedullary nail fixation. Thus we have advanced from the conservative approach to internal fixation in fractures to avoid the co morbidities associated with it. In most centers diaphyseal fractures from 5-15 years have been managed with either stainless steel nails or titanium elastic nails. Flexible intramedullary nailing is so popular now because of its safety, efficacy, ease of implant removal. It gives enough stress at the fracture site for callous formation. And also the implants are inexpensive and technique has short learning curve. But the primary limitation of flexible nails is lack of rigid fixation. In our study we have evaluated the functional outcome in paediatric shaft of femur fractures using flexible intramedulllary nailing using TENS SCORING SYSTEM used by FLYNN [et. al.]. AIMS & OBJECTIVES: 1. To evaluate functional outcome in paediatric femur fractures using flexible intramedullary nailing in department of orthopaedics, Government Stanley Medical College Hospital, Chennai between June 2018 and May 2020. 2. To analyse the functional outcome of paediatric femur fractures treated with flexible intramedullary nailing. MATERIALS AND METHODS: In this study 20 patients of pediatric age group between 5-16 years had Fracture shaft of femur treated with FLEXIBLE INTRAMEDULLARY TITANIUM ELASTIC NAILS (TENS) at Government Stanley Medical College, Chennai between JUNE 2018 and MAY 2020 Each child is followed up for around 12-18 months after the surgery. Postoperatively once the pain settles quadriceps exercises started. After 3 weeks knee and hip mobilization exercises started and partial weight bearing is advised once significant callus is seen in xray. After 6-8 weeks once radiological union is achieved full weight bearing is started. Then followup done on 12, 24 weeks and 1 year. RESULTS: In this study 20 patients of pediatric age group between 5-16 years had Fracture shaft of femur treated with flexible intramedullary titanium elastic nails. Childrens between 5 to 16 years were included in the study with the mean age being 10. 25 years in that 85% of them were boys. In the study group 55% of fractures are due to RTA, 40% were accidental fall while playing, 5% fall from height. 3 cases were open fractures in the study. 14 cases were in middle 1/3 fractures and 6 cases were upper third and middle third junction fractures. All patients were operated on a fracture table in radiolucent table under the guidance of image intensifier. 16 fractures were closely reduced and fixed, in 4 cases open reduction done. In all cases hip and knee range of movements started in 2nd postoperative day except in one case postoperative immobilization is done in the mode of skin traction.The follow up duration was 6 to 18 months. All the fractures united between 8-12 weeks, with average time of union being 8.5 wks. In our study series all the patients had good range of movements except 2 patients who had nail protrusion and skin irritation developed knee stiffness but after removal of nail and physiotherapy. In the study 5 patients had limb length discrepancy, 3 of them had < 5mm lengthening and 2 patients had > 5mm lengthening but not more than 2cm so it is neither significant and functionally disabling. Two patients had superficial infection which settled with antibiotics. 3 patients had varus angulation deformity of 80, 100 and 140 varus which is not functionally disabling. Rotational malalignment is never observed in our study. CONCLUSION: Based on our experience and results ‘ELASTIC STABLE INTRAMEDULLARY NAILING SYSTEM’ is simple, easy, rapid and effective method of treatment in managing paediatric femur fractures in age group between 5-16 years. With shorter operative time, less blood loss, shorter hospital stay, reasonable time of fracture healing, early mobilization making it as a ideal choice of treatment of paediatric femur fractures. It has low complication rate better other modalities of treatment.

Item Type: Thesis (Masters)
Additional Information: 221712059
Uncontrolled Keywords: Elastic stable intramedullary nail, Paediatric femur fractures, Flynn’s criteria, Titanium nailing, Intramedullary nail.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 14:20
Last Modified: 13 Feb 2021 14:20

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