Discusión entre pares / 5yr old child with displaced femur fracture treated with TENS. Critical comments please to improve.

Indian-Orthopaedic Research-Group

Natraj Hm

5yr old child with displaced femur fracture treated with TENS. Critical comments please to improve.

Me gusta

• 

  Raj Kumar Prasad Well done

  14 de septiembre a la(s) 2:59 · Me gusta · 1
• 

  Aashish Raghu We cannot depend on children. Please put patient in Spica also Sir.

  14 de septiembre a la(s) 3:05 · Me gusta · 2
• 

  Mohamed Kamal Nicely done

  14 de septiembre a la(s) 3:13 · Me gusta · 1
• 

  Natraj Hm @Aashish Raghu.. I've put above knee slab mainly to restrain him to bed.. Planning to make him walk full weight bearing after 4weeks..

  14 de septiembre a la(s) 3:14 · Editado · Me gusta · 1
• 

  Paresh Gamara Well done sir pre op X ray is there?

  14 de septiembre a la(s) 3:16 · Me gusta · 1
• 

  Jahangeer Basha Shaik niceno need to bend the ends. it will cause irritation one they start movement.

  14 de septiembre a la(s) 3:17 · Me gusta · 1
• 

  Adarsh Thammaiah Excellent fixation. Good choice of implants. Slab is good to be on the safer side. According to the study u can mobilise after 10 days. Good luck

  14 de septiembre a la(s) 3:17 · Me gusta · 3
• 

  Adarsh Thammaiah Don't worry.it will unite

  14 de septiembre a la(s) 3:17 · Me gusta · 1
• 

  Natraj Hm Its not there in my mobile; tomorrow I'll post the preop xray.. Fracture was fully displaced

  14 de septiembre a la(s) 3:18 · Me gusta
• 

  Jahangeer Basha Shaik nice. no need to bend the ends. it will cause irritation once they start movement at entry site

  14 de septiembre a la(s) 3:19 · Me gusta · 1
• 

  Mithilesh Kumar 2.5 mm or thiker???

  14 de septiembre a la(s) 3:20 · Me gusta · 1
• 

  Jahangeer Basha Shaik

  

  14 de septiembre a la(s) 3:30 · Me gusta · 1
• 

  Kamel Gomaa Shoker Distraction at fracture site 
  Try to hammer the knee
  Keep Ur fixation in splint

  14 de septiembre a la(s) 3:33 · Me gusta · 1
• 

  Somnath Chowdhury do not bend cut ends! it causes more irritation in the local tissue.

  14 de septiembre a la(s) 3:34 · Me gusta · 3
• 

  Somnath Chowdhury if its a closed procedure, the distraction will not matter

  14 de septiembre a la(s) 3:34 · Me gusta · 3
• 

  Jahangeer Basha Shaik no need to hammer , as s.chowdary sir told. if it is a closed method. in 5 yr kid periostieum and # haematoma will look after

  14 de septiembre a la(s) 3:37 · Me gusta · 1
• 

  Natraj Hm Dr Mithilesh kumar thicker one is 3mm and thinner one is 2.5mm.. Canal diameter was 6.5mm

  14 de septiembre a la(s) 4:14 · Me gusta
• 

  Rudra Narayan Pandey It's better you put both nails of same diameter.

  14 de septiembre a la(s) 4:30 · Me gusta · 3
• 

  Natraj Hm Accepted Dr rudra narayan pandey.. 2nd nail was not passing in freely so bit smaller size was used

  14 de septiembre a la(s) 4:38 · Me gusta · 2
• 

  Shreepad R Kulkarni Good job done...but the bent ends creat a problem when they start moving...better keep them straight n remove them early after union...

  14 de septiembre a la(s) 5:25 · Me gusta · 2
• 

  Yugandhar Popa well done doc, distraction can be avoided by simply thumping the bent knee, or straight limb, try these next time...

  14 de septiembre a la(s) 5:56 · Me gusta · 2
• 

  Natraj Hm Actually I tried that but couldn't achieve good compression

  14 de septiembre a la(s) 6:16 · Me gusta · 1
• 

  Biju PA Hi Natu, great work! I think compression occurs once you mobilise the knee actively...

  14 de septiembre a la(s) 6:18 · Me gusta · 2
• 

  Biju PA Mobilise early..

  14 de septiembre a la(s) 6:20 · Me gusta · 1
• 

  Yugandhar Popa In that case u must be observing the fructure site , while driving the nail into the proximal femur , hammering the nail further into the cancellous solid portion of bone , results in distraction...

  14 de septiembre a la(s) 6:26 · Me gusta · 4
• 

  Natraj Hm Pushing the knee during femur nailing helps to get compression but it doesn't work with tens.. Even during previous tens cases it didn't work

  14 de septiembre a la(s) 6:31 · Me gusta · 1
• 

  Natraj Hm U r absolutely right Biju

  14 de septiembre a la(s) 6:32 · Me gusta · 1
• 

  Mithilesh Kumar Rule is 40percent of marrow dia.

  14 de septiembre a la(s) 6:43 · Me gusta · 3
• 

  Natraj Hm I used this formula..Size of each nail= (canal diameter/2) -0.5mm
  This is the formula.. 40% is just apprpximation..

  14 de septiembre a la(s) 6:56 · Me gusta · 4
• 

  Takkallapally Harsha Rao Good job sir. It will unite. One question was the cut tip buried properly

  14 de septiembre a la(s) 7:17 · Me gusta · 1
• 

  Natraj Hm That's my mistake.. Didn't handle the cut ends well but still managed to bury the ends..

  14 de septiembre a la(s) 7:21 · Me gusta
• 

  Pedro Jorba Good result, but the nail tips will cause the child a lot of pain when he starts to mobilize, and they might limit flexion. It's better to leave them almost flat on the metaphysis, as per current recommendations

  14 de septiembre a la(s) 7:22 · Me gusta · 1
• 

  Kunal Makhija

  

  14 de septiembre a la(s) 7:23 · Me gusta · 2
• 

  Pedro Jorba Hardly a comparable case; Natraj's patient had an extremely short, transverse fracture, which would be much more unstable on conservative treatment

  14 de septiembre a la(s) 7:25 · Me gusta · 2
• 

  Natraj Hm Its difficult to maintain reduction with splint or cast.. Options given to parents between spica v/s tens.. They discussed with their family doctor and chose tens

  14 de septiembre a la(s) 7:32 · Editado · Me gusta · 1
• 

  Pedro Jorba I believe TENs were the correct choice in this case

  14 de septiembre a la(s) 7:44 · Me gusta · 1
• 

  Natraj Hm Even I believe the same 

  14 de septiembre a la(s) 7:45 · Me gusta · 1
• 

  Shafeed Marakar Good job

  14 de septiembre a la(s) 7:48 · Me gusta
• 

  Rudra Narayan Pandey I think Dr Mithilesh Kumar was right.
  Natraj Hm your formula is good but 10% magnification in x ray should be taken in account.
  
  Suppose canal diameter is 10mm. Now 10% less means actual diameter is 9mm. By your formula 0.5 is to be subtracted. Means 8.5 remains.
  
  So two nails of 4mm.
  Thats 40% ))))

  14 de septiembre a la(s) 10:31 · Editado · Me gusta · 3
• 

  Natraj Hm Ours is an international hospital so all digital  I calculated in computer monitor..

  14 de septiembre a la(s) 13:14 · Editado · Me gusta
• 

  Ranjan G Hegde good job nats

  14 de septiembre a la(s) 12:03 · Me gusta · 1
• 

  Pedro Jorba Like I commented before, it's better to leave the nail ends parallel to the metaphysis. They're harder to remove, but the patient recovers full range of motion in the knee faster, and has much less pain

  

  14 de septiembre a la(s) 12:08 · Me gusta · 3
• 

  Srinivas Daravathu Good job sir

  14 de septiembre a la(s) 17:12 · Me gusta · 1
• 

  Rajesh Bhat Good one. Ender nails is alternative. Cheaper...

  15 de septiembre a la(s) 11:42 · Me gusta · 1
• 

  Somnath Chowdhury ender's nail is not an alternative for definitive fixation. it works on principles that no textbook recommends/advocates

  15 de septiembre a la(s) 11:56 · Me gusta · 1
• 

  Rajiv Maharjan Natraj Hm: the nails must be of equal diameter to act as perfect coupling else the principle of TENS is voilated, you may get deformation at the fracture side later on.

  15 de septiembre a la(s) 11:58 · Me gusta · 3
• 

  Natraj Hm Thank you gentle men for all the wonderful input.. Really a fruitful discussion.. Good night guys

  15 de septiembre a la(s) 12:37 · Me gusta · 1
• 

  Abdul Hadi Shareef needs compression

  Ayer a las 3:27 · Me gusta · 1
• 

  Mukesh Gupta Gupta great laughter show ,just discuss about opertaion over a 5 yrs old child,many surgeon tells needs of compression what a joke a child of only 5 yrs old just needs compression ,i appericiate the efforts of dr makija,orthopedic i think in wrong direction,childs bone only needs splinatage without any angulation and rotation,with this fixation you can not allow him to walk due pin like hard ware iritation

  Ayer a las 6:25 · Editado · Me gusta