Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures

Finite Element Analysis Could Predict and Prevent a Pathological Femoral Shaft Fracture after En Bloc Resection of a Large Osteoid Osteoma

Osteoid osteoma is a benign tumor. Approximately 20% of these tumors are located in the femur. The tumor primarily occurs in children and is treated by surgical excision or radiofrequency ablation. Recently, bone-tumor resection using three-dimensional (3D) intraoperative imaging with an O-arm in combination with a navigation system has been reported to be effective. However, there is a risk of postoperative fracture because of the weakening of the bone after drilling for tumor resection. A 12-year-old Japanese girl presented with an osteoid osteoma in the left femoral shaft, which resulted in a fracture after en bloc resection and artificial bone grafting using a 3D image-guided (O-arm) assisted navigation system. Orthopedic oncologists should be aware of the risk of fracture. Moreover, they should consider the mechanical risk prediction of bone fracture using finite element analysis prior to treatment.

The Effects of Using K-Wire or Titanium Elastic Nails on Clinical and Radiological Outcomes in the Métaizeau Closed Reduction Technique

AIM

The purpose of this study was to compare the effects of using Kirschner-wire (K-wire) or titanium elastic nails (TEN) on the functional results of patients treated with the Métaizeau closed reduction technique, which is a popular treatment modality for pediatric radial neck fractures (PRNF).

METHODS

Patients who underwent the Métaizeau closed reduction technique for PRNF between May 2017 and May 2019 were assessed retrospectively. The Judet classification was used for the PRNF classification. The study consisted of patients who underwent the Métaizeau technique for Judet Type IV PRNFs and had at least 12 months of follow-up.

RESULTS

This study enrolled a total of 43 patients, 22 females and 21 males. Their mean age was 8.69 ± 2.3 at the time of surgery. The mean MEPS of patients undergoing K-wire surgery was 89.50, while the mean MEPS of patients undergoing TEN surgery was 92.83. There was no statistically significant difference between the two groups in terms of MEPS. When the complication rates of the two groups were evaluated, there was no statistically significant difference between them. The cost per patient for TEN was $40. The cost per patient for the K-wire was $1.

CONCLUSION

The effect of K-wire or TEN used in the Métaizeau closed reduction technique on clinical outcomes is similar, and K-wire is more cost-effective.

A Prospective Cohort Study of the Therapeutic Patterns, Challenges and Outcomes of Paediatric Femoral Fractures in a Cameroonian Tertiary Center

BACKGROUND

Knowledge of the therapeutic patterns, challenges and outcomes of treatment of paediatric femoral fractures (PFF) helps to better choose the ideal therapeutic modality which is still controversial. However, this data is scarce in the sub-Saharan African literature.

OBJECTIVE

To determine the therapeutic patterns, treatment challenges and outcomes of treatment of PFF in a tertiary care centre in Cameroon.

METHOD

We conducted a prospective cohort study of all consenting consecutive cases of femoral fractures in patients younger than 16 years managed between 2011 and 2015 at the surgical unit of Yaoundé University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcomes of treatment at 12 months using Flynn's criteria.

RESULTS

We enrolled 30 femoral fractures from 29 children with mean age was 4.2 ± 3.3 years. The male gender, diaphyseal locations and spiral fracture lines were predominant. Main mechanisms of injury were accidental falls, road traffic accidents and game injuries. Fracture management entailed 12 tractions followed by casting, 10 casting alone, four closed reductions followed by casting, two cannulated screw fixations, one pin fixation and one external fixation. The mean duration of consolidation was 10.3 ± 3.9 weeks. The outcome was rated excellent in 28 cases. Limited resources precluded fluoroscopy use, proper anaesthetic management, early rehabilitation and patient-parent satisfaction.

CONCLUSION

Conservative management of PFF yields a good outcome in our setting. However, an improvement in surgical, radiology and anaesthetic infrastructure is needed for optimal PFF care.

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

PURPOSE

To evaluate the efficacy of intramedullary Kirschner wires for the treatment of unstable tibial shaft fractures in children.

METHODS

This prospective study was conducted at the Department of Orthopaedic Surgery in Maharishi Markandeshwar Medical College from June 2005 to June 2010. Sixty-six children having closed fracture of the tibial shaft with a mean age of 7.7 years (range, 2-14 years) were recruited from emergency and outpatient department. They were treated with percutaneous intramedullary Kirschner wires. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union or malunion. All children were followed for one year.

RESULTS

Children achieved union in a mean time of 8 weeks (range, 6-10 weeks). Postoperatively, three children (4.55%) had delayed union, one (1.52%) valgus deformity of lower leg, three (4.55%) post- operative knee pain and twelve (18.18%) skin irritation at pin site.Wires were removed after 8-22 weeks without any complications. No patient was lost to follow-up. The results were excellent in 95.45% and good in 4.55% children.

CONCLUSION

This technique is cost-effective, simple, quick to perform, safe and reliable and avoids pro- longed hospitalization with good results.