Discusión entre pares / # Femur in a 5 yrs old. Fixed with single Ender nail. no external support.

 

 

Ratnakaran Nambiar

 

 

Orthopaedic Research-Group

# Femur in a 5 yrs old.
Fixed with single Ender nail. no external support.
NWB mobilization from 1st PO day. Planning wt bearing after 20 days.
any suggestions ?

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  P Rajasekhar Rao keeping on thomas splint would have been sufficient

  12 horas · Me gusta · 1
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  Mohamed Galhoum Why u put only one nancy nail

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  Navin Singh single Nancy nail tells even that was unnecessary. ever had a single peg to please your friends? 

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  Mohamed Mekawy Put in a spica or it will rotate

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  Anil Srivastava hip spika for 6 wk always put 2 cross tens nail

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  Satheesh J Philip Since u operated could have put 2 nails

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  Pedro Jorba I agree with most: You should have definitely put in a second nail

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  Rimon Lazar Sliwa

  

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  Rimon Lazar Sliwa

  

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  Sudhir Shelly

  

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  Mohamed Farouk Zaky Good job

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  Ravi Biradar Good...better to delay wt bearing till 4-5weeks

  12 horas · Me gusta
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  Ratnakaran Nambiar firm 3 point fixation clarifies single nail application. I fully agree with what Dr Taral Nagda said ' see the child as your own' and you will find the best option for treatment. I would like to avoid spica where ever possible as I see it a torture to the child. More over here no immobilization of any sort required. Parents will be happy and the child happier

  12 horas · Me gusta
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  Satheesh J Philip This may not be firm enough to allow early mob , which is the while point of surgerye

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  Chan Dran 2 nails criss cross without DRB

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  Alok Shrivastava Why operative ?

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  Murshid H. Alsaki Second nail or one nail+ spica

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  Swapnil Keny Dear Dr Nambiar, A single Enders nail is an inadequate fixation for anybody's child.Since you have inserted one closed, you could have easily inserted the other .The problem is not with fixation. It's with stability of the fracture site.Enders nails do not work on the principle of 3 point fixation as they are non elastic.They work on the principle of canal stacking.Hence the more the better.
  The problem now is counteracting the forces which will be trying to deform this fracture hence you need to be conservative with mobilisation. Though you may be able to get away this time, it may only be due to good luck and nothing else.

  11 horas · Me gusta · 9
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  Rahul Mhatre agree with swapnil keny sir

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  Anshul Garg but wats the need of fixation?? its a well known fact that femoral lengthening is a bigger problem after such fractures!

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  Ahmed Elshemy Wt about rotation how u prevent it by one nsil

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  Remon Lotfy It is not nancy nail . it is ender nail .

  10 horas · Me gusta · 2
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  Ratnakaran Nambiar proximal end of Enders in the neck and entry above the adductor tubercle, there is no chance of rotation

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  Jaideep Dhamele Just keep long term fu as nail may irritate distal medial physis , agree with swapnil sir

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  Anil Kumar How did you ensure NWB walking in 5yr child

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  DrBahaa Yahya Ok. He can. But why not 2 elastic nails

  

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  DrBahaa Yahya

  

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  DrBahaa Yahya For more stabilization

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  Latif Abdul nailing of this type is indicated for patients from 5 to 11yrs as per Rockwood green

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  Nikhil Goradia I alwsys use two nails from opposite cortices... just like dr. Yahya. Gives good 3 point fixation and avoids rotatory problems.

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  DrBahaa Yahya Ok. He can. But why not 2 elastic nails

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  DrBahaa Yahya The point of insertion in distal femur in epymetaphysis or what?? In general. Good thank you dr. Good luck

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  Jeejan Gangadharan No three point fixation.TENS WOULD HAVE BEEN BETTER AND THAT TOO 2 atleast .

  8 horas · Editado · Me gusta · 1
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  Jalal Achji You have to apply another nail or spika..

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  Freddy F Galvis Gomez good job.

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  Shabir Hussain wondrful job.

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  احنا بتوع اﻻتوبيس Good job but not enouph for early w b . This fixation doesn't follow the role of internal fixation. But this fracture pattern give stability for reduction . According to roles of AO you need for 2 rods to apply 3 point fixation 
  Any way just delay wb until seeing enough callus to avoid angulation.

  4 horas · Me gusta · 2
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  Parag Paradkar TENS better implant and gives more stability, this is inadequate fixation

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  Nyo Nyo Win Hlaing I think 1 nail 2 nail is not the problem. If # is accept; wait another 1 to 2 months also not problem. Its very short time for her life. Important thing is not to become a criple child. Femur is ball and sock jt. Therefore rotation can b compansate by its anatomical nature. Stable unstable is protect by delay weight bear or external splintage. Even with 2 nails can't allow early weight bear. Its also need to a time for union for walking. My interesting is how about the LLD after mature age. As u all know # & infection have very good osteoblastic activity & good remodelling power. Also repair & compansatory power of growth plate and # site from femur is very strong coz it is the greatest growing bone in children. We were taugh that paediatric femoral SOF only need to keep in only acceptable position. Its doesn't anatomical. Its need only function. We respect the child remodelling power. Overlapping 1 inch is better than anatomical interdigitation. The younger the child the more lenghtening in adult life; ie LLD. Conservative tx is better than Optive tx esplt younger child. Actually I have seem some child with more lenghen effective limp with well form involucrum of COM at adolescent age. How wonderful lenghtening is > 1 inch and they come to consult for uneven limbs. I want to know the end results of anatomical opted paed # SOF in adolescent age. Its only one my idea and thinking. If any wrong with my post responsibility is to me. Excuse me if any wrong my idea. Plz discuss Sir.