Details
Category: Volume 08 Issue 07 July 2020
Hits: 968

Title: Outcomes in tibial diaphyseal fractures in adolescent age group managed by titanium elastic nailing system

Authors: Mansoor Ahmad Tali, Dr Sayar Ahmad Mantoo, Dr Akhter Rasool, Dr Imtiyaz Ahmad Beigh

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.93

Abstract

Objectives: In this prospective study we studied radiological and functional outcomes of unstable tibial shaft fractures in adolescent age group that were managed by titanium elastic nailing. Although most pediatric tibial shaft fractures are managed by closed reduction and casting, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) have emerged as a suitable surgical modality for pediatric tibia fractures owing to the benefits such as easy surgical technique, early weight-bearing, early union and early discharge from hospital.

Materials and Methods: In this prospective study we managed 25 patients of unstable tibial diaphyseal fractures by TENs nailing. The mean age at injury was 10 years and 6 days (range of 8–17) years. In each patient, ante-grade nailing was performed by inserting a TENs nail in the medial and another TENs nail in the lateral side of the proximal metaphysis. Modified Flynn’s criteria were used to assess union, alignment, leg-length inequality and complications.

Results: All the patients’ fractures got united and the healing time was 10 weeks and 5 days in average. No case of nonunion or significant malunion or epiphyseal injury was encountered. No patient had a sagittal or coronal angulation of over 10°. Among patients with open fractures, four had superficial surgical site infections and one had a deep wound infection. All the infections were successfully treated with appropriate antibiotics. Patients with open fractures took longer time to heal than close fractures. Nearly full range of motion was achieved at knee and ankle in all cases. 16 (64%) patients had an excellent outcome, and 9 (36%) patients had a satisfactory outcome.

Conclusion: For unstable tibial shaft fractures in adolescent age group, TENs is a  safe and effective treatment modality. It is minimally –invasive, thus causes less soft tissue injury, short surgery time, rapid recovery and fewer complications.

Keywords:  Unstable tibial diaphyseal fractures, Adolescent age group, TENs.

References

  1. Galano, G.J.; Vitale, M.A.; Kessler, M.W.; Hyman, J.E.; Vitale, M.G. The Most Frequent Traumatic Orthopaedic Injuries from a National Pediatric Inpatient Population. Pediatr. Orthop. 2005, 25, 39–44.
  2. Joeris, A.; Lutz, N.; Wicki, B.; Slongo, T.; Audigé, L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr. 2014, 14, 314.
  3. Myers, S.H.; Spiegel, D.; Flynn, J.M. External Fixation of High-Energy Tibia Fractures. Pediatr. Orthop. 2007, 27, 537–539.
  4. Mashru, R.P.; Herman, M.J.; Pizzutillo, P.D. Tibial Shaft Fractures in Children and Adolescents. Am. Acad. Orthop. Surg. 2005, 13, 345–352.
  5. Pandya, N.K.; Edmonds, E.W. Immediate Intramedullary Flexible Nailing of Open Pediatric Tibial Shaft Fractures. Pediatr. Orthop. 2012, 32, 770–776.
  6. Heo, J.; Oh, C.-W.; Park, K.-H.; Kim, J.-W.; Kim, H.-J.; Lee, J.-C.; Park, I.-H. Elastic nailing of tibia shaft fractures in young children up to 10 years of age. 2016, 47, 832–836.
  7. Kubiak, E.N.; Egol, K.A.; Scher, D.; Wasserman, B.; Feldman, D.; Koval, K.J. Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation? Bone Surg. Am. 2005, 87, 1761–1768.
  8. Patel NK, Horstman J, Kuester V, Sambandam S, Mounasamy V. Pediatric tibial shaft fractures. Indian J Orthop. 2018, 52, 522–528.
  9. Berger, P.; De Graaf, J.; Leemans, R. The use of elastic intramedullary nailing in the stabilisation of paediatric fractures. 2005, 36, 1217–1220.
  10. Swindells, M.G.; Rajan, R.A. Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. Child. Orthop. 2009, 4, 45–51.
  11. Pandya, N.K.; Edmonds, E.W.; Mubarak, S.J. The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures. Child. Orthop. 2011, 5, 439–447.
  12. Gustilo, R.B.; Anderson, J.T. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. Bone Joint Surg. Am. 1976, 58, 453–458.
  13. Flynn, J.M.; Hresko, T.; Reynolds, R.A.K.; Blasier, R.D.; Davidson, R.; Kasser, J. Titanium Elastic Nails for Pediatric Femur Fractures: A Multicenter Study of Early Results with Analysis of Complications. Pediatr. Orthop.2001, 21, 4–8.
  14. Ligier, J.; Metaizeau, J.; Prévot, J.; Lascombes, P. Elastic Stable Intramedullary Pinning of Long Bone Shaft Fractures in Children. J. Pediatr. Surg. 1985, 40, 209–212.
  15. Pennock, A.T.; Bastrom, T.P.; Upasani, V.V. Elastic intramedullary nailing versus open reduction internal fixation of pediatric tibial shaft fractures. Pediatr. Orthop. 2017, 37, 1.
  16. Patel NK, Horstman J, Kuester V, Sambandam S, Mounasamy V. Pediatric tibial shaft fractures. Indian J Orthop. 2018, 52, 522–528.
  17. O’Brien, T.; Weisman, D.S.; Ronchetti, P.; Piller, C.P.; Maloney, M. Flexible Titanium Nailing for the Treatment of the Unstable Pediatric Tibial Fracture. Pediatr. Orthop. 2004, 24, 601–609.
  18. Sankar, W.N.; Jones, K.J.; David Horn, B.; Wells, L. Titanium elastic nails for pediatric tibial shaft fractures Child. Orthop. 2007, 1, 281–286.
  19. Onta, P.R.; Thapa, P.; Sapkota, K.; Ranjeet, N.; Kishore, A.; Gupta, M. Outcome of diaphyseal fracture of tibia treated with flexible intramedullary nailing in pediatrics age group; A prospective study. J. PublicHealth. 2015, 3, 65–68.
  20. Debnath, S.; Debbarma, S.; Sarkar, A. Titanium elastic nailing osteosynthesis for diaphyseal tibial fracture in pediatrıc age group-our experience. Indian J. Appl. Res. 2017, 7, 52–53.
  21. Başaran, S.H.; Erçin, E.; Çümen, H.; Daşar, U.; Bilgili, M.G.; Avkan, M.C. The titanium elastic nailing in pediatric tibia fractures caused pedestrian versus motor vehicle accidents. Bakirkoy Tip Derg. 2016, 12, 188–194.
  22. Kc, K.M.; Acharya, P.; Sigdel, A. Titanium elastic nailing system (TENS) for tibia fractures in children: functional outcomes and complications. Nepal Med. Assoc. 2016, 55, 55–60.
  23. Vallamshetla, V.R.; De Silva, U.; Bache, C.E.; Gibbons, P.J. Flexible intramedullary nails for unstable fractures of the tibia in children: An eight-year experience. Bone Joint Surg. Br. 2006, 88, 536–540.

Corresponding Author

Dr Sayar Ahmad Mantoo

Senior Resident Orthopaedics, GMC Srinagar, J&K