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العنوان
Comparative Study between Nancy Nail and Conservative Treatment in Diaphyseal Fracture Tibia in Children /
المؤلف
Abdulfatah, Ahmed Gamal.
هيئة الاعداد
باحث / احمد جمال عبد الفتاح
مشرف / تامرعبدالمجيد محمد فياض
مشرف / أحمد سعيد علي
تاريخ النشر
2018.
عدد الصفحات
165 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة العظام والطب الرياضي
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة العظام
الفهرس
Only 14 pages are availabe for public view

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from 165

Abstract

Treating tibial shaft fractures in the pediatric patient can be challenging for the orthopedic surgeon. The vast majority of these fractures are best treated with closed reduction and casting. Frequent radiographic follow up is often necessary for a successful result. External fixation is reserved for fractures associated with soft tissue injury. Intramedullary fixation has recently gained in popularity but should be reserved for specific indications. Compartment syndrome is a potential complication of tibial shaft fractures. Early recognition and fasciotomy is paramount to preventing muscle necrosis. Good clinical outcomes can be expected for most tibial shaft fractures in the pediatric population.
ESIN of diaphyseal fractures of the lower extremity is restricted to fractures that cannot be easily handled by cast immobilization. Increasingly, operative treatment is being used even in less difficult cases to allow early motion and mobilization and to prevent displacement.
ESIN of the lower leg is an established method for treatment of complete diaphyseal fractures of tibia and fibula in children. The position of this method may be between cast application and external fixation. Good indications are complete transverse fractures and oblique fractures, while the use of ESIN in comminuted fractures is critical. With proper monitoring of the postoperative clinical situation the related complications are controllable and outcome is good in the vast majority of patients.
In addition, the minimal invasive character of this method, with less damage of the structures at the fracture site, supports rapid healing with stimulation of periosteal and endosteal callus growth. This method enables micromotion at the fracture site, resulting in a shorter consolidation and remodeling time of the bone.
ESIN is an ideal device for treating pediatric tibial fractures allowing mobilization and maintenance of alignment until bridging callus forms. The device would exploit the rapid healing and ability to remodel without risking the physis or blood supply to the tibia.
 Fracture union and full weight bearing with return to normal activity were earlier in ESIN studies.
 Angulation in both the coronal and sagittal planes was higher in the cast studies than in the ESIN studies.
But there are some disadvantages about ESIN such as:
 Can’t be used in all fractures such as comminuted and spiral fractures.
 Not preferred in heavy weight children ≥ 50kg. (36)
In conclusion, the present study supports the treatment of tibial shaft fractures in children aged 8.1-13.5 years with ESIN, as it hastens fracture union, and allows earlier, weight bearing, rehabilitation and return to normal activity.
Further trials with longer follow-ups and comparison of ESIN with other methods, such as external fixation or plating in children’s tibial shaft fractures are recommended.