Paediatric diaphyseal femur fracture treated with intramedullary titanium elastic nail system

noBackground &amp; Objectives: Over the few years there has been a marked increase in the use of intramedullary fixation in the management of fracture of shaft of femur in children. The goals should be to stabilize the fracture, to control length and alignment, to promote bone healing and to minimize the morbidity and complications for the child. In this prospective study we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur treated with elastic intramedullary nail.Materials &amp; Methods: All 56 patients with diaphyseal fracture shaft of femur were treated with titanium elastic nail and followed for period of 32 weeks.Results: The In this study, outcome was assessed by using Flynn’s criteria of titanium flexible nail outcome score and we found excellent result in 49 cases, satisfactory in six cases and poor in one case. We faced one major complication in form of implant failure and six minor complications inform of superficial wound infection.Conclusion: Elastic intramedullary nail used in treatment of diaphyseal fracture shaft of femur yield excellent functional and radiological outcome. It is easy and simple procedure has low rate of complication. It is physeal-protective, cost effective, does not involve heavy instrumentation and can be performed in small set up. It has minimal risk of infection and no risk of injury to the neurovascular structure.JCMS Nepal. 2015; 11(2):20-22</p

A Morphometric Study of Lumbar Spine Pedicles in Nepalese Population

Background and Objective: In this observational study, morphometric data were obtained and analyzed by taking plain x-rays in various age groups to establish the morphometric values in Nepalese population. Methods: All the pedicle dimensions were measured by taking plain x-ray AP (Antero-posterior) and Lateral view of the lumbar spine in 246 Nepalese of different age groups. Pedicle diameters (Vertical and Horizontal) and interpedicular distance were measured in AP radiographs and sagittal angle was measured in the lateral radiographs. Differences between mean dimensions of pedicles of male and female of various age groups were tested by using ANOVA, independent t-test was used to test the individual mean dimensions. Results: Mean values of the pedicle dimensions were found as: Horizontal diameter (L1=7.17mm, L2=7.26mm, L3= 9.50mm, L4= 10.57mm and L5=11.3mm), Vertical diameter (L1= 15.00mm, L2=15.28mm, L3=15.21mm, L4=13.44mm and L5= 12.59mm), Interpedicular distance (L1= 25.54mm, L2 =27.03mm, L3 = 27.70mm, L4 =28.62mm and L5= 31.29mm) and the sagittal angle (L1=17.83degree, L2=15.7degree, L3= 15.91degree, L4=13.94degree, and L5=12.97degree) respectively. Conclusions: Values of pedicle dimensions found in Nepalese population by this study can be guidelines for the transpedicular procedure and for further research activities. DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12972 JCMS Nepal 2014; 10(4):12-17</p

Soft bandage versus casting in the treatment of torus fracture of distal radius in children; a prospective randomized study

Background &amp; Objectives: Various methods of immobilization have been recommended for the treatment of torus fracture of distal radius in children. The purpose of this study is to determine if soft bandage is as effective and safe as below elbow circumferential casts in the treatment of torus fracture of the distal radius in the children.Materials &amp; Methods: Children from 4 to 14 years of age, who presented to emergency and outpatient department of orthopaedics and trauma at National Academy of Medical Sciences with an isolated torus fracture of distal radius, were randomized and treated with either soft bandage or below-elbow plaster cast by the same investigators. Patients with associated neurovascular injuries, bilateral torus fractures, concomitant physeal injuries and associated musculoskeletal injuries were excluded. The patients were followed up at weekly interval for 4 weeks and analyzed with VAS, ROM and outcome questionnaire and data were analyzed by using SPSS 18.Results: Among the 114 patients analyzed, 57 patients were kept in soft bandage group and 57 in below-elbow cast group. The mean age in soft bandage group was 8.29 year and the mean age in below-elbow cast group was 8.55 years. There was no significant difference between the two groups with regard to patient demographics, initial fracture characteristics and mechanism of injury.Conclusion: Treatment of distal radius torus fracture with soft bandage is a cost-effective and safe in the children below 14 years of age. These minor fractures are stable and not subject to the risks of late displacement which can be very effectively treated symptomatically to provide pain relief by using soft bandage only and educating the parents about the nature of this paediatrics fracture.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 3-8</p