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Introduction: Orthopedic surgeons treat femur shaft fractures more frequently in children. Pediatric femoral shaft fractures (FSFs) can be surgically stabilized using a variety of techniques, such as rigid intramedullary nailing, compression plating, and external fixation. An internal splint that shares the load and facilitates both mobilization and alignment maintenance would be the perfect therapy tool. The purpose of this research is to determine the function of TENS in the fixation of children patients’ femur shaft fractures. Materials and Methods: This prospective research had been done in our hospital’s orthopedic department. Fifty patients, aged 5 to 15 years, who had femur shaft fractures were surgically managed with TENS. The patients were monitored clinically as well as radiologically for 6, 12, and 24 weeks, or until the fracture healed. Results: Flynn’s scoring system was employed to assess the clinical outcomes, assigning a score of excellent for 40 patients (80%), satisfactory for 10 patients (20%), and poor for none of the patients. Bone union took an average of 10.78 weeks. Conclusion: TENS is an easy, less time-consuming, and effective way to treat pediatric shaft femur fractures. It has several benefits, including a short recovery period, fewer hospital stays, early mobilization, and a low rate of complications.

This case report presents a unique instance of a 25-year-old male patient successfully treated with Titanium elastic nail (TEN) for a distal clavicle fracture, a method typically reserved for midshaft clavicle fractures. Distal clavicular fractures, constituting 12%-15% of all clavicle fractures, often necessitate surgical intervention to avoid complications such as malunion and persistent pain. While standard surgical therapies include Kirschner wire and hook plate fixation, this case explores the benefits of TEN, known for minimal tissue disruption and faster recovery. The patient, who suffered a severe left shoulder injury after falling, underwent a minimally invasive TEN procedure. Post-surgery, he showed a significant reduction in pain and improvement in shoulder mobility, with radiographic evaluations confirming successful fracture reduction and stable fixation. The case underscores the potential of TEN as a viable alternative for distal clavicular fractures, though further research is needed to establish comprehensive guidelines for its application.

Abstract Background Nonunion of femoral shaft fractures in children is rare, and there is no clear treatment protocol. In this case report, a pediatric femoral shaft fracture that developed in nonunion due to vitamin deficiency after osteosynthesis, which was successfully treated with vitamin augmentation and replacement with a rigid antegrade intramedullary nail, is described. Case presentation The patient is an 11-year-old Japanese girl. She injured her right femoral shaft fracture when she hit a wall after kickboarding down a hill and underwent osteosynthesis with a titanium elastic nail. Six months postoperatively, she developed nonunion, was found to be deficient in vitamins D and K, and was started on vitamin supplementation. She underwent replacement with a rigid antegrade intramedullary nail at 7 months postoperatively, and bone union was achieved 3 months after reoperation. Conclusion When delayed union of a fracture is observed postoperatively, even in children without underlying disease, the cause of the problem must be investigated and treated promptly.

Abstract Background The aim of this study was to compare two techniques for the surgical treatment of diaphyseal fractures in the adult humerus: double-crossed retrograde elastic stable intramedullary nailing (DCR-ESIN) and limited-contact dynamic compression plate (LC-DCP). Methods This was a retrospective study conducted at a single hospital. We included 122 patients with diaphyseal fractures of the humerus who had received DCR-ESIN or LC-DCP from January 2011 to January 2017. We compared union rates, union times, disabilities of the arm, shoulder, and hand (DASH) scores at the postoperative 1-year follow-up, and complications between the two groups. Results Plating management was performed in 63 patients, while DCR-ESIN was performed in 59 patients. The union rate was higher in the DCR-ESIN group than in the LC-DCP group (100% vs. 90.5%; p = 0.052). The union time was shorter in the DCR-ESIN group than in the LC-DCP group (12.0 weeks vs. 14.8 weeks; p

ObjectiveTitanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment.MethodsThe literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software.ResultsA total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = −1.3, 95%CI(−1.94,-0.66), p 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = −0.67, 95% CI(−2.01,0.67), p > 0.05] were found.ConclusionIn comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur. Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially. Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =

Purpose: The aim of this study was to compare the clinical and radiological results of paediatric tibia shaft fractures treated by intramedullary fixation with Kirschner (K) wire and titanium elastic nail (TEN). Materials and Methods: Thirtynine patients were evaluated retrospectively. Included 20 patients treated with TEN (group 1) and 19 patients treated with K-wire (group 2). At the end of the 1-year follow-up, radiological measurements for malalignment and the Flynn TEN outcome scoring system were used to compare the clinical results. Results: According to the Flynn classification, in group 1, results were excellent in 75% and good in 25%, and in group 2, excellent in 70% and good in 30%. In any cases has not been experienced physeal early closure or refracture, nor did they need re-manipulation or re-operation, and no implant insufficiency was detected. Malalignment was found in four patients in group 1, and in two patients in group 2 of lesser than 10 degrees. Conclusions: Even though two methods showed similar clinical and radiological results, fixation paediatric tibial fractures with K-wire may have some advantages as lower-cost and easy accessibility according to TEN.

Objective To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning. Methods From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21–58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow‐up radiographs to monitor related complications were evaluated as well. Results All patients were followed‐up with a mean of 21.8 months (range, 12–28 months). The average range of elbow flexion‐extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85–100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0–14), and the VAS for pain was 0.33 ± 0.78 (range, 0–2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve. Conclusion Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.

Aim: Plate fixation and titanium elastic nailing are conventional surgical treatment modalities for both-bone forearm fractures in children. The purpose of this study is to assess the functional and radiographic results of these techniques and compare with literature. Patient and Methods: We evaluated data of 36 children retrospectively. Twelve of the patients (group 1; 1 girls, 11 boys, age range 9-15 years) were treated by open reduction plate fixation and 24 of the children (group 2; 3 girls, 21 boys, age range 9-14 years) were treated by closed reduction intramedullary nailing. Mean total time from fracture until the surgery was 4.3 and 6.1 days in group 1 and 2, respectively. We compared the groups according to union duration, the number and the severity of the complications and clinical outcomes according to Price criteria. Results: Mean follow-up duration was 22.0 months in group 1 and 19.7 months in group 2. Mean age was 13.0±1.2 years and 11.7±1.6 years in group 1 and 2, respectively. According to Price criteria, we obtained no poor outcomes in both groups. The rate of excellent outcome was 75% and 87.5 % in group 1 and 2, respectively. Union was obtained in 7.6 weeks and 6.7 weeks in group 1 and 2, respectively; this difference was statistically significant (p

Aim: The purpose of this investigation was to present our institutional experience of 34 pediatric both bone forearm fractures treated with titanium elastic intramedullary nails. Methods: Thirty-four patients, who were treated with titanium elastic nail for both bone forearm fractures diagnosis between 2011 and 2016, were included in the study. Clinical and radiological evaluation of the patients was retrospectively analyzed. Results: Bone healing process was completed for all patients at a mean of 6.6 weeks. The implants were removed at a mean time of 9.7 months from the index operation. Complications, including skin infections at the entry side of the nail, were recorded in three (8.82%) patients. These three patients had type 1 open fracture according to the Gustilo-Anderson classification and were treated with first generation cephalosporins. In a subjective measure of outcome during follow-up, it was observed that 33 patients (97.06%) were very satisfied and one (2.94%) was satisfied; no patient reported being not satisfied. Conclusion: Since titanium elastic nailing is a safe and effective method of treatment with advantages of easy implantation and removal as well as excellent cosmetic and functional results, elastic stable intramedullary nailing is the first treatment option that should be considered in pediatric both bone forearm fractures.

Abstract Background To investigate whether closed reduction and internal fixation (CRIF) with titanium elastic nails (TENs) is a viable alternative treatment in proximal radial fractures. Methods In Kaohsiung Veterans General Hospital, from November 2013 to April 2015, five adult male patients with forearm injuries (average age 43 years; range 35–64 years) were treated for proximal radial shaft fractures. CRIF with TENs for radial shaft fractures was performed in these five patients. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated in our study. Results Mean follow-up period was 30 months (range 28–36 months). Average time of radius union was 7.3 months (range 6–10 months). Functional outcomes 1 year after operation revealed an average Quick DASH score of 7.92 (range 4.5–25), an average VAS of 1.5 (range 1–3), and average forearm supination and pronation of 69.2° (range 45°–75°) and 82.5° (range 80°–85°). No major complication was noted. Conclusions CRIF with TEN for adult proximal radial fractures is a method to avoid extensive exposure or nerve injury during ORIF, especially in multiple trauma patients who require short operative time, uremia patients with ipsilateral forearm AV shunt, severe soft tissue swelling due to direct muscle contusion or strong muscularity before surgery, extensive radial fracture, and those in pursuit of cosmetic outcomes.

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

This study has two purposes: (1) to compare the clinical results between the Titanium Elastic Nail (TEN) and plate fixation of the displaced midshaft clavicle fracture; and (2) to demonstrate the relationship between length shortening and functional outcome after TEN fixation, especially in the comminuted fracture pattern. A retrospective, case-controlled study was conducted and 55 patients were included in our study: 25 in the TEN fixation group (TEN group) and 30 in the plate fixation group (plate group). All patients were classified into four subgroups: simple fracture in the TEN group (ST; n = 13), simple fracture in the plate group (SP; n = 15), comminuted fracture in the TEN group (CT; n = 12), and comminuted fracture in the plate group (CP; n = 15). Wound size was significantly smaller in the TEN group (p

Introduction: Clavicular injury is common in active and younger age group with male preponderance (male-female ratio is 2:1). Purpose of this study was to analyze the outcome of surgically treated displaced fracture midshaft clavicular fracture using Intramedullary fixation by titanium elastic nail. Materials and Methods: We present a series of cases of midshaft clavicular fracture who were subjected to Intra medullary fixation with the average nail diameter of 2.5 to 3 mm titanium elastic nail system by the closed/open reduction method under Image intensifier control. Results: Average time taken for full clinical and radiological union was nine weeks (with minimum six weeks to maximum eleven weeks). Time taken for fully functional recovery (time of functional disability) was 35±7 days in all patients except in two cases of floating shoulder and one case of poly-traumatic patient in which it was 50 days. Follow-up period ranged between 9 months and 24 months with an average of 18 months. Average ConstantMurley-Score after assessment of shoulder function was 96.8. Conclusion: Titanium elastic intra-medullary nailing is a promising surgery with excellent functional outcome, safer percutaneous method with less invasive nature and rapid healing tendency with fewer complications in contrast to plate osteosynthesis.