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Background:Femoral shaft fractures are one of the most common fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable.Objective:This study investigated the efficacy, safety, and outcome of surgical intervention with Elastic Stable Intramedullary Nailing (ESIN) in 3–12-year-old children with diaphyseal femoral fractures and compared them with those of conservative management.Methods:In this prospective study, 41 children with diaphyseal femoral fractures were recruited between April 2013 and April 2016. The fractures were divided into two equal groups: one treated with ESIN, and the other with early spica casting or noninvasive traction followed by hip spica casting. Demographic data, clinical information, and serial radiographic findings were collected and compared between the two groups. Flynn’s scoring criteria pertaining to time to union, assisted weight bearing, independent ambulation, return to school, and complications were applied. Fischer’s exact test was used for statistical analyses.Results:Compared with spica casting-treated fractures, ESIN-treated fractures healed faster with lower average time to assisted weight bearing, independent ambulation, and return to school. Hip spica-treated children had a higher rate of major complications than ESIN-treated children. At 1-year follow-up, higher limb length discrepancy was reported in hip spica-treated children than in ESIN-treated children (P< 0.001).Conclusion:ESIN is a safe and effective approach for treating femoral shaft fractures in children; it provides better functional and radiographic outcomes than spica casting and can be used in preschool-age children.

Background: Diaphyseal forearm fracture are common injuries among children, its treated either conservatively or surgically, closed reduction cast immobilization remain the current gold standards for treating these injures, but angular & rotational malunion result in functional disability in older children. Intramedullary nailing of forearm fracture is an alternative method especially in case of failed closed reduction and cast immobilization. The aim of our study is to value the outcome of using flexible elastic nail in pediatric diaphyseal forearm fractures. Methods: This study is a prospective study was conducted in Erbil city from January 2016 to January 2017 on forty-nine pediatric patients with diaphyseal forearm fractures treated surgically with titanium elastic nailing system (TENS), thirty-three boys & sixteen girls, twenty-one fractures on right side and twenty-eight on left side, age range between 5-15 years with mean age of 9 3.1three patients had polytraumatic injury , the fracture had been classified according to descriptive classification, Average follow up was11± 2months for 43 children. Result: In 43 of 49 patients, the operative procedure was done as primary treatment, completed within the first 24 hours after injury. In six of the patients, secondary displacement occurred after attempted conservative therapy, and in those cases the procedure was performed after 8 ± 3 days. Operating time averaged 42 ± 15 min. The average time that radiographs showed bridging callus on the antero-posterior and lateral views was 13 weeks for both radius and ulna, Ten of the 49 patients were given aboveelbow splints postoperatively, Implant removal was performed after an average of 6.3 ± 1.7 months, the radiological results are documented regarding angulation and displacement. The functional results are documented, there were no observed cases of refracture, 6 months after hardware removal all patients pain free with no limitation of movement and activities, 37 patients were rated as excellent outcome, three with good out come and three with poor out comes. Conclusion: Flexible elastic nail is an effective and minimally invasive method of diaphyseal forearm fractures with excellent results in terms of bony union and functional out comes with minimal complications and without jeopardizing the integrity of the physes.

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012Citation: Mustafa SM, hwaizi LJ (2018) Outcome of Treatment of Displaced Intrartcular Fracture Calcaneus by Plate and Screws. Open J Orthop Rheumatol 3(1): 012-019. DOI: http://dx. AbstractBackground: Management of calcaneal fractures has always been in controversy. Many treatment techniques have been described. In this prospective study, we studied the functional outcome of surgically treated intra-articular calcaneal fracture. Aim of study:To study the functional outcomes and complication in the surgically managed calcaneal fracture. Patient and Methods:A total of 24 Patients with 26 calcaneal fractures operated in west emergency and Erbil teaching hospital over a period of 18 months (January 01, 2016 to August 01, 2017) were included in the study, Pre-operative computed tomography (CT) scans carried out in all patients. Maryland foot score was used to evaluate to assess the functional outcome and study complication.Results: Twenty-four patients (22 unilateral and 2 bilateral), mean follow up 18 month, the mean age being 35.41 years (range 18-60 years), consisting of 3(12.5%) female and 21(87.5%) male were included in the study. Most common mode of injury was fall from height in 23(95.8%) patients, while road traffi c accident was in 1(4.16%) patients. Three patients had associated spinal injuries. Results according to Maryland foot score were excellent in 25%, good in 62.5%, and none of the patients had poor results. Complications include synovitis, broadening and superfi cial infection. Conclusion:ORIF with restoring the articular congruity with low profi le locking plate is the ideal treatment for joint depression type and Sanders Type II/III and IV. Even Sanders Type IV (which was thought to be associated with poor results) had a good outcome in short-term follow-up. Use of proper surgical timing/technique/under aseptic precaution can lead to good or excellent results in more than 90% of patients and avoiding the majority of the complications. Thus ORIF in these patients should be encouraged.

Background and Objectives: to compare the outcome of open reduction-internal fixation with plate and screws method and closed reduction-flexible intramedullary nailing method in the management of pediatric patients with unstable forearm fractures as regard to functional and cosmetic outcome. Patients and Methods: The final assessments of 42 pediatric patients between the ages of 5 to 15 years old, who were operated from April 2010 to February 2011 for both-bone forearm fractures in Erbil Teaching Hospital and Private Hospital with adequate follow up, were done and their medical records were prospectively evaluated. Results:42 children with unstable forearm fractures 21 were treated with open reduction and internal fixation of both radius and ulna using plate and screws (Group1)(mean age ,13years) and 21 were treated with close reduction and flexible intramedullary fixation (Group2)( mean age ,11years). Patient characteristics in the 2 groups were compared. In Four patients of Group 2, closed reduction was not possible because of soft tissue interposition that required open reduction with minimum incision at the fracture site. All patients achieved bone union; the mean union times were similar (P value=0.81), only one patient in each group had delayed union. Operating times were shorter in flexible nailing group (100 minutes in Group1 vs. 69 minutes in Group2, p<0.001). Conclusions: There was no significant difference in union rate between the methods. The functional outcome between the two groups was compared; there was no significant difference between them. Like other investigators, we also found 90.5% of excellent functional outcomes after the treatment of unstable forearm fractures by means of plating. As indicated in the literature, we found 95% of excellent functional results after flexible intramedullary nailing.

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