Original Research ArticleIntroduction: Femoral shaft fractures are most common fractures in paediatric age group having different options to treat them. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Objective: The aim of this study is to evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Material and Methods: 36 femoral shaft fractures in 36 children aged 6-14 years were fixed with titanium intramedullary elastic nail between July 2017 and December 2018 in the department of Orthopaedics, Shaheed Ziaur Rahman Medical College Hospital, Bogura, and in some private hospitals in Bogura, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al. scoring criterion. Results: All patients achieved complete healing at a mean of 9.1 (Range 8-10) weeks. 31 fractures were reduced by closed means but 5 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 4 patients. 86% had excellent result and 14% had satisfactory. Conclusion: Elastic stable intramedullary nailing is the method of choice for the femoral shaft fractures in paediatric patients, because it is minimally invasive and shows very good functional and cosmetic result. It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.
Background: Tibial plateau fractures are serious injuries resulting frequently in functional impairment. Low and high-energy tibial plateau fractures usually result from axial loading in combination with valgus stress forces, present a variety of soft tissue and bony injuries that can produce permanent disabilities. Since there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Aim of the study: The aim of this study was to evaluate the functional outcome of surgical management of tibial plateau fractures. Methods: It was a prospective observational study and it was conducted in the Department of Orthopaedics & Traumatology, TMSS Medical College, Bogura, Bangladesh during the period from January 2018 to December 2018. The total of cases included in the study was 56 in number. More than 20 years old patients of both sexes with tibial plateau fractures attended to the mentioned hospital during the first six months of the study were selected as the study population. All simple or Gustilo Anderson Grade I fractures of tibial plateau presenting in patients requiring open or closed reduction and internal fixation to restore the articular anatomy were finalized for this study. Result: In this study among total 56 participants 37 were male which was 66.07% and 19 were female which was 33.93%. On the other hand in this study we found satisfactory outcome in 50 patients which was 89.29% and not satisfactory in 6 patients which was 10.71% among all the participants. Final end result as per Rasmussen's criteria was excellent in 34 (60.71%), good in 9 (16.07%), fair in 7 (12.50%) and poor in 6 (10.71%) patients. Conclusion: In this study we found satisfactory outcome in 50 patients which was 89.29% and not satisfactory in 6 patients which was 10.71% among all the participants. These findings may be helpful for the future researchers for any further research in the same issue.
Original Research Article Femoral shaft non-union is a functional and economical challenge for the patient as well as a treatment dilemma for the surgeon. The Association for Osteo-synthesis (AO)' as a means of preventing the development of fracture disease and early recovery. Intramedullary (IM) nailing is the gold standard for the management of femoral shaft fractures. To find out the Functional outcome in exchange nailing with autogenous cancellous bone graft for aseptic nonunion of femoral shaft. From July 2015 to June 2017, more than 30 patients of femoral shaft aseptic nonunion were treated with this technique at Pabna Medical College Hospital and clinics in Pabna, Bangladesh. 21 patients were finally recorded for study. Among them 1(one) patient was lost after 04 weeks before fracture healing. Culture of the 1st reaming materials revealed growth in 2 cases. So, final outcome, analysis and test of significance were done with 18 patients. Mean age 41.95 Years; SD ± 13.11; Male: Female = 3.3:1 Among 18 fractures nonunion, 15 fractures (83.33%) were united and 3 fractures (16.67%) were not united after exchange nailing with autogenous bone graft in aseptic condition. Confidence Interval at 95% level 66.08%-100%. Mean union time was 26.00 ±4.5 weeks where 95% confidence interval was 23.49±28.51weeks including both static and dynamic mode of fixation. In static mode mean union time were 29.33±3.01 weeks whereas in early dynamic it was 21.33±1.63 weeks. It was also calculated that after late dynamization mean union time was 28.67±2.309 weeks. Among complications unacceptable Angle deviation 5.6%, Limb length discrepancy 5.6%, Pain-Swelling 5.6%, Infection 11.12%, Joint motion restriction 5.6%, Implant failure 5.6%. There was a strongly positive correlation between age and union time; that means more the age more the union time. In this study, it was found that smoking and NSAIDs both had significant relation (p<0.05) with fracture union time. Highly strong (+) ve correlation was found between non union period and union time after exchange nailing. Final outcome according to modified Thoresen's score was Satisfactory78%; according to modified Silvia's score was 10.83 ± 2.203. In fracture united cases postoperative SF-MFAS Function Index was achieved 2.5 ±1.7and Bother index was achieved 1.89±1.08.There was a highly significant (p<0.001) difference between pre operative and post operative functional outcome after exchange nailing with open bone graft as a whole. Exchange nailing with autogenous cancellous bone graft seems to be an effective method of treatment in femoral shaft nonunion after intramedullary nailing. It provides a good scope to reinforce the optimum mechanical stability by a larger diameter nail and locked if necessary; as well as biological stimulation by reaming and open bone grafting.
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