A STUDY OF BOTH-BONE FOREARM FRACTURES IN PEDIATRIC POPULATION-TREATED BY ELASTIC STABLE INTRAMEDULLARY NAILING WITH TITANIUM ELASTIC NAILING SYSTEM

Dr. K. Usha Sree and Dr. B. Someswara Reddy Post Graduate, Professor and HOD, Department of Orthopedics, Santhiram Medical College and General Hospital, Nandyal. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 05 March 2020 Final Accepted: 07 April 2020 Published: May 2020

Introduction:Diaphysealfractures of the radius and ulna are one of the most common in the pediatric population estimated around 40% of all pediatric fractures.Conservative management with closed reduction and immobilization with above elbow cast can lead to malunion.The introduction of titanium elastic nailing system has changed the treatment scenario. The aim of this study is to evaluate the functional outcome of management of both bone forearm fractures by closed reduction and internal fixation with titanium elastic nail system Materials and Methods: A total of 20 patients aged 5-15 years with fracture of both radius and ulna were managed by internal fixation with titanium elastic nails. Closed reduction under image intensifier was achieved in most of the patients. Results: Results wereanalysed in reference to union, range of movements of adjacent joints and symptoms.86% showed excellent results , 8% showed good results ,6% showed fair results. Conclusion: Better functional outcome with less complications were achieved with ESIN with TENS.

…………………………………………………………………………………………………….... Introduction:-
Diaphysealfractures of the radius and ulna are one of the most common in the pediatric population.About 75% of forearm fractures occur in the distal third,15% occur in middle third, 5% occur in proximal third.Fractures of forearm of children are different than adults. Periosteum is thick and less likely to be torn. Greenstick and torus fractures occur exclusively in children. Conservative management with closed reduction and immobilization with above elbow cast can lead to malunion.The introduction of titanium elastic nailing system has changed the treatment scenario.
The titanium elastic nailing system (TENS) provides the following four properties: flexural stability, axial stability, translational stability, and rotational stability. All four properties are essential for achieving optimal results.The elastic stable intramedullary nailing has benefits of immediate stability to the involved bone segment which permits early mobilization and returns to normal activities with low complication rate.

Surgical technique of tens nailing:
A patient was put in the supine position on operating table with the affected arm placed on a radiolucent arm table.Titanium elastic nails of appropriate diameter were chosen.The nail diameters were about half of the medullary isthmus of each bone. An awl was used to make entry point in the bones. Entry point in the radius was either justproximal to the radial styloid or through Lister's tubercle. The entry point in the ulna can be at the posterior aspect of the olecranon or a lateral approach through the proximal metaphysis.The retrograde entry point in the ulna was through the distal metaphysis. Because the radius is often more difficult to reduce, it should be splinted first. Radial nail was inserted manually with the inserter for TEN into the medullary canal, with the nail tip at right angles to the bone shaft. Then, the nail was rotated through 180° with the inserter and the nail tip was aligned with the axis of the medullary canal. The nail was advanced up to the fracture site . The radial nail tip was aligned with the medullary canal of the proximal fragment. Then, the nail was advanced into proximal fragment metaphysis. Ulna nail was then introduced and progressed in similar manner such as radius nail. When the nails were correctly positioned in the opposite metaphysis, protruding nail ends are cut approximately 1 cm from the bone. In most of our cases, closed reduction was done. In few cases, where closed reduction could not be achieved, mini-incision was given over fracture site for the reduction of fracture and internal fixation with titanium elastic nail done.

Postoperative:
POP given for 2 weeks for soft tissue healing. Early range of movements started.

Follow-up:
Every patient followed up at 4weeks intervals till union occur.

Results:-
Results were analysed in reference to age, sex,mode of injury, time of union, complications.