Evaluation of Outcome of Paediatric Long Bone Shaft Fractures by Titanium Elastic Nailing

Abstract

Aim: To study the type of injury and clinical profile of various long bone diaphyseal fractures in children. To study the merits and demerits of Titanium Elastic nails in the management of various long bone diaphyseal fractures in children with regard to intra operative and post operative clinical and radiological characteristics (i.e., functional status, union of the fracture and post operative complications.) Objectives: To achieve near anatomical reduction, prevent joint stiffness & to obtain good range of motion, prevent deformity are the objectives of the treatment. Introduction: The incidence of paediatric trauma is highest among developing world reflecting the realities of urban violence, firearms and the dangers of highly mechanized society. Recent years have witnessed a shift towards a greater role for operative management for many children fractures. In most instances operative management produces better results than non operative treatment. Materials and methods: The study included 18 cases of various paediatric long bone fractures treated with flexible elastic nailing. The study was done at department of orthopaedics in Narayana Medical College and Hospital, Chintareddypalem, Nellore. The study was done over a period of two years from Oct 2012 to Apr 2014 with sequentially selected cases. Results: Eighteen patients of various long bone fractures of the age group between 6-12 years were treated by closed/ open reduction and Titanium Elastic nail fixation. 66.7 % fractures involved on the right side. The most common mode of injury was Road traffic accident in 61.11 % cases. 88.88 % of patients were reported to hospital within 3 days of injury. Two cases of associated fractures were seen. 90 % of patients were operated within 3 days of admission and all of the patients were operated within 5 days of injury. 50 % of the patients were operated within 50 minutes with an average operating time of 50 minutes in our study. The average blood loss was 55ml and no patient in our study required blood transfusion per operatively or post operatively. The average hospitalization time is 5 days. Most of our patients were able to do partial weight bearing with crutches by the end of 2 weeks. 77.77 % of our patients were able to do full weight bearing by the end of 9 weeks and all of the patients were able to do full weight bearing by 12 weeks post operatively one proximal migration of the nail was observed. In one patient shortening of less than 2cms was noted. Knee stiffness was observed in 4 cases. We recorded zero mortality rates. There were no cases of infection either superficial or deeply. All the fractures united within 4 months of operation and average time taken for union was 10 weeks. We were able to achieve good to excellent anatomical results in 83 % of patients whereas good to excellent functional results were obtained in 83 % patients. Conclusion: This method is less traumatic, gentle and one of the simplest methods known. This method is based on sound biomechanical. The intramedullary position of the implant places it more in line with the weight bearing forces thereby reducing the tendency of the fracture to settle in a deformed position. The excellent biomechanics is reflected by the absence of implant failure. No case of delayed or non union in the present study. Early ambulation is one of the advantages of the Titanium Elastic nailing.This helps to minimize the duration of hospital stay and complications of enforced bed rest like pneumonias, bed sores, UTI, thrombo embolic phenomenon, etc.