A prospective study of functional outcome of treatment of fracture shaft femur in children using titanium elastic nails system

Abstract

Introduction: Femoral shaft fractures are common fractures in paediatric age group. Males are affected more commonly than females, they represent 1.6% of all bony injuries in children. In children, fractures of the femoral shaft have been traditionally treated mostly by conservatively immobilization in a Spica cast, either immediately or after a period of traction. But this safe form of treatment has two major drawbacks. First prolonged bed rest separates the child from his normal environment; and the second the cost of such periods in hospital stay is more and the use of beds which might serve other needy patients.Materials and Methods: This is a prospective study carried out to evaluate the outcome, time taken for union of fracture and complication with use of TENS. Thirty consecutive patients of fracture shaft femur in children between 6-16 years admitted in Department of Orthopaedics, Maharaja Institute of Medical Sciences, Nellimarla, Vizianagaram were considered for the study. All patients were taken up surgery within seven days of their injury. Informed consent was taken from all patients. Patient selected on basis according to inclusion and exclusion criteria as under.Results: Age of patients was between 7 to 15 years with mean of 11.3 years. Male patients were double the number of females. Right femur was more frequently involve and pattern of fracture was predominantly transverse 60 %. Mean hospital stay was 6.47 days with a range of 5-7 days. Time between injury and operation was between 5 to 7 days and mean of 7.73 days. In all patient active and passive movement was possible 3 weeks. Partial weight bearing was started after 3 weeks and full weight bearing was possible after union in maximum of 10 weeks’ time. Bridging callus at least three cortices was first noted on follow-up radiograph at an average of 3 weeks at which time partial weight bearing was started. Majority of the patients (25) achieved union by 6 weeks with average time to union being after 10 weeks and at this time full weight bearing was started.Conclusion: Titanium elastic nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of good and excellent outcomes in children aged 6-16 years. Technical pitfalls can be eliminated by adhering to the basic principles.