Surgical Management of Fracture Shaft of Femur in Children aged between 5 to 16 years using Elastic Stable Intramedullary Nailing

Manikandan, J (2008) Surgical Management of Fracture Shaft of Femur in Children aged between 5 to 16 years using Elastic Stable Intramedullary Nailing. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Femoral shaft fractures account for 1.6% of all PAEDIATRIC INJURIES. In children 5 years or younger, early closed reduction and application of spica cast is an ideal treatment for most diaphyseal fracture. In skeletally mature adolescents, use of antegrade solid intramedullary rod has become standard treatment. But, the best treatment for children between five to sixteen years of age is still debated. Compared with younger children, patients in this intermediate age group have high risk of shortening and malunion when conservative measures used. Children managed with traction and spica cast as a treatment modality has to undergo various adverse physical, social, psychological and financial consequences, of prolonged immobilization. Various other modalities include external fixation, plates and screws, use of solid antegrade intramedullary nail are available. However, the risk of certain complications, particularly pintract infection and refractures after external fixation or osteonecrosis with solid nails. In the past seven years fixation with flexible intramedullary nails have become popular technique, for stabilizing femoral fracture in school aged children. ESIN fixation system is a simple, effective and minimally invasive technique. It gives stable fixation with rapid healing and prompt return of child to normal activity. This study was intended to assess the results following treatment of fracture shaft of femur by flexible intra medullary nail or elastic stable intramedullary technique. AIM: The purpose of this study is to analyze the efficacy of ELASTIC STABLE INTRAMEDULLARY NAILING (TENS) in the treatment of fracture shaft of femur in children aged between 5 to 16 years with special emphasis on technical difficulties and complications MATERIALS AND METHODS: In this study 20 patients aged 5-16 years, with fracture shaft of femur were treated with flexible intramedullary nail with TITANIUM ELASTIC NAILS (TENS) at Government Rajaji Hospital attached to Madurai Medical College, Madurai from May 2006 to November 2007. Inclusion Criteria: • Children and adolescent patients from 5 to 16 year with diaphyseal femur fracture. Exclusion Criteria: • Patients less than 5 years of age and more than 16 years of age. • Patients unfit for surgery • Comminuted and segmental fractures. • Fracture involving the distal 1/3rd of femoral shaft. RESULTS: All patients were followed until fracture union occurred. The followup period ranged from 6 months to 18 months. Results were analysed both clinically and radiologically. The results were evaluated according to the TENS SCORING SYSTEM used by FLYNN et al. Majority of the patients i.e. 8 (40%) were in the age group of 5-8 years. The younger patient was 5 years and the oldest was 15 years and the mean age of study was 10.15 years. Majority of patients were males and 2 were females. Major Cause of fractures in our series is RTA. Right femur involved in 55% of cases. Middle 1/3rd of the shaft was involved in 12 (60%). Associated Injuries: Head Injury -2, Abdominal Injury -1, Ipsilateral Tibia -1, Pelvic fracture -1. Average Time interval between trauma and surgery was 3.95 days. One patient who had a head injury problem, we operated after 2 wks needed an open reduction. Another patient who had compound required open reduction. We done postoperative immobilization in two cases in form of skin traction in a Thomas Splint, both were comminuted fractures. 2 patient who had superficial infection stayed more than 12 days in hospital. Average duration of hospital stay in our series in 10.1 days. CONCLUSION: Twenty patients with 20 diaphyseal fractures were treated with Elastic Stable Intramedullary nailing between May 2006 to November 2007 at Government Rajaji Hospital, Madurai. Children and adolescents aged between 5 to 16 years were included in this study with the average age being 10.15 years and 90% of them were boys. RTA is the major course for the fractures and 2 fractures were open fractures. 12 cases were in middle 1/3 fractures and 8 of them were upper third and middle third junction fractures. All patients were operated on a fracture table. 18 fractures were closely reduced and fixed, 2 cases open reduction done. Except one case we allowed active hip and knee range of motion exercise on 2nd post operative day we allowed partial weight bearing around 3-4 wks and full weight bearing only after clinical and radiological complete union was evident . Based on our experience and results, we conclude that ELASTIC STABLE INTRAMEDULLARY NAILING technique is an ideal method for treatment of pediatric femoral shaft fractures. It gives elastic mobility promoting rapid union at fractures site and stability which is ideal for early mobilization. It gives lower complication rate, good outcome when compared with other methods of treatment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Management ; Fracture Shaft of Femur ; Children ; 5 to 16 years ; Elastic Stable Intramedullary Nailing.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:25
Last Modified: 17 Sep 2017 05:22

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