Evaluation of Results of Titanium Elastic Nailing System in Paediatric Lower Extremity Fractures of Long Bones

Abstract

BACKGROUND: Flexible intramedullary nails have gained widespread popularity for stabilization of pediatric fractures of long bones of lower extremity. AIMS: Purpose of our study was to evaluate safety and efficacy of titanium elastic nailing system (TENS) for paediatric lower extremity long bone fractures. METHODS: All children operated for lower extremity long bone fractures at our tertiary care centre (Sri Aurobindo Institute of Medical Sciences, Indore) between Jan 2012 to Dec 2013 who underwent fixation with TENS were reviewed. Out of 57 cases identified, 4 cases were lost to follow-up. Of the 53 cases, 58.49 per cent were males (boys 31 and girls 22). The average age of patients was 10.8 years (range 6-14 years). The mean weight was 28.8 kg (range 16 kg-42 kg). All fractures were reduced by closed manipulation. Outcomes were classified as excellent, satisfactory or poor according to Flynn flexible nail fixation classification. RESULTS: As per Flynn classification, we had 36 excellent, 14 good and 1 poor result. All patients attained complete healing at mean of 11.2 weeks (Range 7-16 weeks). Mean duration of hospital stay was of 5 days (Range 3-16 days). CONCLUSION: On the basis of results obtained TENS is an effective method for management of unstable paediatric fractures of long bones of lower extremity allowing rapid mobilization with minimal complications.

Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures

“…Each K-wire provides three points of fixation: one at the entry point, a second at the apex of the curve of the K-wire and a third at the tip, which is embedded in the cancellous bone of the proximal metaphysis. Stability is provided not only by the intramedullary K-wires, but also by the bone itself and surrounding soft tissues 8, 34, 35, 36. The bone provides axial stability and each wire provides three point fixations.…”

“…The bent tips provide rotational stability. Increasing the number of K-wires enhances the stability of fixation 8, 34, 35, 36. Kiely et al tested the mechanical properties of different combinations of flexible nails in a model of a paediatric femoral fracture.…”

“…Cosmetic damage is minimal as compared to other open techniques like plating. In contrast with the plaster immobilization, it affords advantages of easy nursing care, early mobilization and avoidance of psychological problems due to prolonged immobilization 8, 34, 35, 36. As the children are mobilized early on axillary crutches, they can return to school and play activities earlier.…”

“…Locking intramedullary rods are not used in children because of the risk of physeal injury. Treatment options include external fixation,5, 6 elastic stable intramedullary nailing,7, 8 and transfixion pins and casts 9, 10. Intramedullary fixation with elastic nails that is placed percutaneously through the distal femoral metaphysis without violating the physis has become a popular technique for the treatment of femoral fractures in children 11, 12.…”

“…Two flexible intramedullary nails, introduced in an antegrade or retrograde fashion, cross the fracture site and act as internal splints to maintain length and alignment while allowing sufficient fracture motion to generate callus formation. This technique is commonly referred to as elastic stable intramedullary nailing or flexible intramedullary nailing 8 . It has been used successfully for the treatment of paediatric fractures of the tibia, femur, humerus and forearm 13, 14, 15.…”