RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA,
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE / Dr. NARASIMHA MURTHY.N.ADDRESS / No 205,B3, KRISHNA BLOCK, NGV,
KORAMANGALA,
BANGALORE-47.
2 / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE.
3 / COURSE OF STUDY AND SUBJECT / M.S.IN ORTHOPAEDICS
4 / DATE OF ADMISSION / 29th APRIL 2010
5 / TITLE OF THE TOPIC / MANAGEMENT OF DIAPHYSEAL FRACTURES OF FEMUR IN CHILDREN BY TITANIUM ELASTIC NAILING SYSTEM (TENS)
6. BRIEF RESUME OF INTENDED WORK
6.1. NEED FOR STUDY:
Treatment of long bones fractures in children continues to improve as newer techniques evolve. Though most of the fractures can be effectively managed conservatively, unstable and displaced fractures need fixation to provide good results. Although a number of other intramedullary devices like rush nail or ender’s nail are available for treatment of paediatric long bone fractures, yet these have poor elasticity, rotational stability and require multiple nails to achieve fracture stability1
We are receiving cases of long bone fractures in children in our hospitals, which are treated by various modalities. Titanium Elastic Nailing System done for long bone fractures in children is less invasive with minimal blood loss with minimal hospital stay, aids early mobilization and is economical too. Hence I intend to study our experiences, complications , and outcomes in the use of titanium elastic nails for diaphyseal fractures of femur in our setup. This method hopes to bring back the smiles and activity at the earliest in the suffering children.
6.2.Review of literature:
Hassam M Kandil stated that Traction & Hip Spica casting has long been employed as one of standard method for treatment, and surgical treatment was limited to open fractures. Currently with development of new fracture implant and system, the management method have created a shift in case of femur shaft fractures strictly from non surgical care to surgical stabilization. 2
James H.Beaty, et al, Rockwood and Wilkins’ Fracture in children states that the flexible nailing technique offered satisfactory fixation, enough stress at fracture site to allow abundant callus formation, and relatively easy insertion and removal. The implants are inexpensive and technique has a short learning curve. 3
Flynn et al opined that, as newer techniques evolve in the treatment of long bone fractures, Titanium Elastic Nailing System may prove to be the ideal implant to stabilize paediatric femur fractures which avoids the prolonged immobility and complication of traction and even spica casting.4
Atul Bhaskar concluded that Elastic intra medullary nailing of long bone fracture is an excellent technique in surgical treatment of long bone fractures in children. It is safe, less invasive and associated with fewer complications.5
Bary M Patterson J.M. concluded that Titanium Elastic Nailing System technique offers several advantages including a better reduction, dynamic stabilization, Short hospital stay with early functional recovery. 6
6.3. Aims and Objectives of the study:
To study the various aspects of managing diaphyseal fractures of femur in children aged between 5-15 years by using Titanium Elastic Nailing System. Particular attention is given in careful choosing of the patient. Subjective and objective study of clinical parameters like pain, comfort to the patients, early mobilization, operative techniques, radiological evaluation for union, stages of weight bearing till complete recovery and any associated complications by using Titanium Elastic Nailing System .
7. Materials and methods:
7.1. Source of Data:
1. Patients admitted at Victoria hospital and Bowring & Lady Curzon Hospital attached to Bangalore Medical College & Research Institution
2. Follow up in out patient Department
7.2. Method of collection of data:
Collection of data from thirty Children admitted with diaphyseal fractures of femur is as follows-
· History by Verbal communication from the child and/or informant.
· Clinical examination, both local and systemic
· Base line investigation
· Basic Radiological Examination
Admitted patients are evaluated by paediatrician for fitness, routine pre anesthetic check-up will be done and informed written consent will be taken before surgery.
· Intra operatively -Position of the Patient, bony land mark and surgical incision for the nail Insertion ,reduction modalities under image intensifier, time needed for surgery, blood loss and any other difficulties faced during the procedure is care fully noted, including sizing and suitability of titanium elastic nails as per A.O. guidance
· Post operatively after 24 hours - Wound Inspection, Check X-ray to assess reduction and active static exercises/ passive exercises / active neighbouring joint movement at the earliest
· Between 8 to 10 days - wound inspection and suture removal
· Patient is called for periodic follow up at 4 weeks, 8 weeks, 12 weeks, 6 months and 12 months and clinical and radiological assessment will be done
Inclusion Criteria:
Children between age 5 to 15 years having following type of diaphyseal fractures of femur.
1. Fresh closed displaced / un displaced diaphyseal fractures.
2. Fresh Type I and Type II open fractures.
3. Closed comminuted fractures.
4. Segmental fractures.
Exclusion criteria:
1. All open fractures having secondary infections or suspected deep infections or late presentations (>10 days)
2. All type III open fractures
3. Closed fractures more than 2 weeks old
4. All metaphyseal fractures with / without involvement of epiphysis
5. All pathological fractures
6. Parents / patient not willing for surgery
7. Children suffering from epilepsy, heart diseases, neuro muscular diseases and
bleeding Diathesis are excluded from our study.
Statistical analysis – using descriptive study
7.3. Does the study require any investigation or interventions to be conducted on patients or other humans or animals. If so please describe briefly.
· Investigation includes routine blood, urine, and radiological examination.
· No animal studies required.
· Titanium elastic nailing will be done for diaphyseal fractures of femur in children age group of 5-15 years which is considered as minimal invasive procedure.
7.4. Has the ethical clearance obtained from your institution.
Yes.
8. LIST OF REFRENCES:
1. Lee. SS et al Ender nail fixation of paedicatric femur fracture a biomechanical analysis J. paedicatric ortho (Am) 2001; 21: 442-445.
2. Hassam M.Kandil, Titanium Flexible intramedullary nailing of Paediatric Femoral shaft fractures KASR:EL AIN1 Medical Journal VOL 13, NO 3, May 2003, PP45 -50.
3. James H Beaty, john.M Flynn and David L. Skaggs; Rock wood and Wilkin’s fracture in children seventh edition. Chapter 22, Pp 809.
4. Flynn, et al Titanium Elastic Nails for Paediatric Femur Fractures. A Multicentre study of early results with analysis of complications Journal of paediatric orthopaedics Jan / Feb 2001; Volume: 21, issue / PP4 -8.
5. Atul Bhaskar: Treatment of long bone fractures in children by flexible Titanium Elastic Nails :Indian journal of orthopaedics Traumatology 2005 ; Vol: 39 issue 3 pages 166-168.
6. Barry. M. Paterson J.M. Flexible Intramedullary nails for fracture in children. J.Bone Joint surg (Br) 2004; 86: 947 - 953.
7. Sanders J.O, Browne RH, Mooney F et al Treatments of femoral shaft fractures in children by paediatric orthopaedics. Results of 1998 posna survey. J. paediatric ortho 2001 ) 21: 436-441
8. S. Terry Canale et al Campbell’s Operative orthopaedics, Eleventh Edition. Volume 2 ; Chapter 33, Pp 1657 – 1659
9. SIGNATURE OF THE CANDIDATE:
10. REMARKS OF THE GUIDE:
This method is a standard surgical procedure being carried out in our institution , since last few years sparsely. I have under gone A.O. paediatric fracture management course at Vellore by A.O. international foundation and faculty during the year 2009. Since then, we have adopted the same procedure successfully for around 10 cases and found very effective and suitable. Availability of image intensifier instrumentation is of no problem. The need for systematic and impartial study of this technique and its suitability and effectiveness to our setup is the stimulus for this dissertation.
11. NAME & DESIGNATION OF
11.1 GUIDE
Prof DR A. RAMALINGAIAH
M.S.ORTHO
Professor of Orthopaedics
Department of Orthopaedics
BMC-RI.
SIGNATURE:
11.2 HEAD OF THE DEPARTMENT
Prof DR .N.VIJAYAKUMAR
M.S.ORTHO
Professor of Orthopaedics
Department of Orthopaedics
BMC-RI.
SIGNATURE:
12. REMARKS OF THE CHAIRMAN AND PRINCIPAL:
SIGNATURE:
1