PurposeLiterature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures.MethodsThe study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5–12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n = 17) or stainless steel (n = 17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria.ResultsBased on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group.ConclusionMajority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

As an elective procedure, total knee arthoplasty is under scrutiny to evaluate clinical and functional outcome. In this regard, we examined 32 knee arthoplasty to assess factors associated with better functional outcome. METHOD: It is a prospective study of 32 knee cases in between 2006-2012. In this 28 knee had osteoarthritis knee and 6 knee had rheumatoid arthritis. Infective, traumatic and metabolic bone disease knees were excluded from study. All patients were evaluated by American knee society score (KSS and functional score).RESULT: Total knee arthoplasty was found to be associated with substantial functional improvement. The greatest amount of improvement is seen within few months after surgery with more gradual improvement occurring up to years of surgery. CONCLUSION: Total knee arthoplasty is a very effective procedure for overall functional improvement and pain relief of the patient with arthritic knee.

BACKGROUNDMetaphyseal fractures of long bones of lower limb are difficult to manage. In our study, we have evaluated the radiological and functional outcome of minimally invasive plate osteosynthesis (MIPO) technique for metaphyseal fracture of femur and tibia. MATERIALS AND METHODSA total of 37 metaphyseal fractures of long bone of lower limb were included in the study. The fractures were treated with minimal incisions, both at proximal and distal ends of plate. The anatomical metaphyseal locking plate was then inserted subperiosteally and the fracture was bridged after which the plate was fixed. The patients were followed up and the progresses were evaluated at regular interval by Johner-Wruhs' criterion and lower extremity functional score. RESULTSAll the fractures united well. The mean time of union of distal femur, proximal and distal tibia are 18 (range 14 -24), 18 (range 14 -22) and 17 (range 16 -24) weeks respectively. The mean range of motion at knee of fracture around knee was 105°, while for fracture at ankle the range of motion was a mean dorsiflexion of 19° and mean 30° plantar flexion. According to Johner-Wruhs' criterion results were excellent in 14, good in 17, fair in 5 and poor in 1 patient. By LEFS system, 34 patients have no difficulty in doing their work, while only 3 patients have a little bit of difficulty. No patients required bone grafting. The complication rates were also low. CONCLUSIONFor metaphyseal fractures, MIPO can be regarded as an optimal treatment modality which achieves good bone union and functional results with minimum soft tissue damage.

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