Introduction: Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation.Methods: This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination.Results: Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture.Conclusions: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions.
Keywords: complications; functional outcomes; tibia fractures. | PubMed
The management of displaced, intra-articular calcaneal fracture represents a surgical challenge to even an experienced orthopedic surgeon. Plate osteosynthesis using an extended lateral approach is complicated by soft tissue problems, while those treated by closed reduction and percutaneous pinning cannot address all the intra-articular fragments sufficiently. The objective of our study is to evaluate restoration of subtalar joint and long-term functional outcomes in intra-articular displaced calcaneal fractures treated with transverse subcondral screws through a small incision on lateral aspect of calcaneus and percutaneously placed axial screws through the calcaneal tuberosity. Forty-five intra-articular calcaneal fractures were managed with this minimally invasive technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively and last follow-up visit. Functional outcomes were assessed on the basis of American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score. Preoperative calcaneal length, height, width, Bohler's angle, and Gissane angle were improved from 68.62 ± 2.64 to 72.44 ± 2.63 mm, 39.28 ± 2.72 to 32.37 ± 2.65 mm, 47.04 ± 2.56 to 49.55 ± 2.45 mm, 12.66° ± 2.86° to 26.93° ± 2.57°, 123.91° ± 3.13° to 96.06° ± 3.92°, respectively, after surgery with P value <0.001. There were 21 (46.7%) excellent, 17 (37.8%) good, 4 (8.8%) fair, and 3 (6.7%) poor outcomes based on AOFAS ankle/hindfoot scores. Time to unite the fracture was 11.06 ± 1.82 weeks (range 8-16 weeks), and all fractures were united without major complications. Minimally invasive technique through a small incision on lateral aspect of calcaneus gives a moderately good exposure for anatomical restoration of Sander's type II and III calcaneal fractures fixed with both transverse and axial screws under fluoroscopic guidance.
Introduction: Total hip arthroplasty (THA) is a well-established procedure for advanced arthritis of the hip joint. It significantly improves the quality of life by relieving pain and improving functional disability. The objective of this study was to evaluate the clinical and functional outcome of primary total hip arthroplasty using the Harris Hip Score.
Method: Prospective study was conducted in Civil Service Hospital. Out of 145 THA performed from Jan 2014 to Dec 2018, the first 100 cases that fulfilled the inclusion criteria were analyzed. Patient demographic and site, operative indication, and pre-operative Harris Hip Score was documented. Operative time, total intraoperative blood loss, and complications were noted. Patients were followed in 3 weeks, 6 weeks, 3 months, 6 months, and yearly. In each visit, clinical evaluation using Harris Hip Score and radiological evaluation was done and documented. The duration of follow up ranged from 12 months to 4.5 years.
Results: Age varied from 21 to 75 years, 59% were male and 41% female, right side involvement was seen in 55% and left side in 45%. The major indication for surgery was avascular necrosis 46% and primary osteoarthritis in 24%. The average operative time was 65 minutes and the average intraoperative blood loss was 655 ml. Pre-operative Harris Hip Score ranged from 25 to 59 with a mean of 45.5. The mean Harris hip score in last follow up increased to 90.5 with a minimum of 76 and a maximum of 97. Our study found that 85% had excellent, 9% had good and 6% had fair results. Complications include 2% dislocation, 1% infection, 1% greater trochanter avulsion and 1% screw irritation.
Conclusion: Primary THA is a safe and effective procedure. It improves pain and function hence improving the activity of daily living and has fewer complications.
Background: Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion that can be achieved by either closed reduction and casting or surgical intervention. Number of surgical treatment modalities have been mentioned for unstable pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing
Methods: This was descriptive cross-sectional study performed from January 2016 to December 2019. A total of 85 diaphyseal pediatric forearm fractures were treated surgically with TENs during this period. Functional outcomes and complications were analysed 6 months after surgery.
Results: The mean age of patients in our study was 10.67±1.88. There were 50 (64.1%) male and 28 (35.9%) female. Incidence of fracture is higher in left side 47 (60.2%) in comparison to right side 31 (39.8%). Thirteen (16.7%) fractures were in proximal third, 50 (64.1%) in middle third and 15 (19.2%) in distal third of both bone forearm.There were excellent outcomes in 91%, good outcomes in 6.4% and fair results in only 2.6% of patients.Seven different types of complications were noted including skin irritation 8 (10.2%), cortex perforation in 2 (2.5%) and iatrogenic fracture in 1 (1.3%) case.
Conclusions: Titanium elastic nailing is excellent treatment option for displaced unstable pediatric both bone fractures especially in elderly children. This is technically easy, minimally invasive procedure where bone healing is relatively fast, implant removal is easy with excellent cosmesis of skin without long ugly scar in forearm.
Background: A nail and cement spacer is one of the option for the reconstruction of the proximal humerus after tumor resection among prosthesis unaffordable patients. However, making the cement spacer anatomically match its replacement remains challenging.
Presentation of case: A 12-year-old boy was diagnosed with osteosarcoma in the right proximal humerus by core needle biopsy. After preoperative neo-adjuvant chemotherapy, a wide resection was performed, and the defect was reconstructed with an anatomically matched cement spacer. The cement spacer was fabricated using 3D-printed moulds, which were made according to the mirror image of the left humerus based on CT data. The post-operative course was uneventful, and at the 12-month follow-up, the patient is able to move with only some restriction in abduction and upward lift. The MSTD score was 21.
Conclusion: Fabrication of an anatomically matched cement spacer using 3D-printed moulds is a simple, inexpensive, and reproducible procedure for reconstruction complex bone defect.
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