BHUMIT_SRC_ for pediatric forearm fracture in childrenPPT2.pptx

Elastic intramedullary nailing in Pediatric forearm fracture in children

1. PROSPECTIVE OBSERVATIONAL STUDY OF FUNCTIONAL OUTCOME OF ELASTIC MEDULLARY NAILING OF FOREARM FRACTURES IN CHILDREN . PI – DR.BHUMIT KIRITBHAI SHELADIYA First year PG resident Dept of Orthopaedic Govt Medical College, Bhavnagar PG Guide: Dr. NARENDRA MISHRA Associate professor Department of orthopaedics , Govt Medical College Bhavnagar

2. Study overview Study Design : Prospective study Study Setting(Site): Orthopedic Department, Sir T Hospital, Bhavnagar Aim: To evaluate the functional ramifications of employing forearm elastic intramedullary nailing as a therapeutic intervention for paediatric forearm fractures.

3. Introduction The shaft fractures of the radius and ulna cover 5–10% of all bone fractures in children . Their incidence has increased markedly in recent years . The fractures are most common in the summer months. A wide majority (90%) of the fractures occur outdoors and dry weather increases the risk of fractures by 50% compared with rainy days . The surgical treatment of forearm shaft fractures in children has also increased: the incidence of elastic stable intramedullary nailing (ESIN) increased from 13 to 53%. There is no doubt that forearm shaft fractures are potentially harmful and challenging to manage . They are unique and they differ from fractures of any other long bones . They are one of the few paediatric fractures that show a real risk of complications and prolonged morbidity.

4. Why this study is essential? The aim of this study is to know What are the functional outcomes, including range of motion, strength, and quality of life, in children with forearm fractures treated using forearm elastic intramedullary nailing

5. Aim & Objectives Aim: To meticulously evaluate the functional ramifications of employing forearm elastic intramedullary nailing as a therapeutic intervention for pediatric forearm fractures. It seeks to discern the extent to which this surgical approach enhances outcomes pertaining to range of motion, strength, and overall quality of life among affected children. PRIMARY OBJECTIVES: 1. To assess the functional outcomes, including range of motion, strength, and quality of life, following forearm elastic intramedullary nailing in children with forearm fractures   SECONDARY OBJECTIVE: 1) To assess the rate of fracture healing and alignment restoration achieved through forearm elastic intramedullary nailing. 2) To assess the incidence of complications, such as malunion, nonunion , or implant-related issues, associated with this surgical technique. 3 )To evaluate patient satisfaction and parental perception regarding the treatment process and outcomes.

6. Methodology Study Design : Prospective observational study Study Population : Paediatric patients (aged <14 years) who have sustained forearm fractures and have undergone treatment with forearm elastic intramedullary nailing. STUDY SITE : Orthopaedics department – SIR T GENERAL HOSPITAL, BHAVNAGAR - GUJARAT Duration : 18 months Duration of Data collection : 15 months Sample Size : All paediatric patients of forearm fracture undergoing treatment with elastic intramedullary nailing within study period coming to orthopaedic department , sir t hospital Bhavnagar.

7. Methodology Inclusion criteria: Age range 0–14 years of both genders Closed both bone diaphyseal radius and ulna fractures and single bone diaphyseal radius or ulna fractures Open grade 1 both bone diaphyseal radius and ulna fractures and single bone diaphyseal radius or ulna fractures

8. Exclusion criteria Hybrid fixation (IM nail and plate)

9. LIST OF VARIABLES : 1.Independent variables: Age, Gender, Type of fracture, Type of treatment (elastic intramedullary nailing in forearm fractures) 2.Dependent variables : Functional outcomes (range of motion, grip strength, pain levels, etc.) 3.Confounding variables : Severity and type of fracture Presence of any additional injuries Compliance with postoperative rehabilitation protocols Surgeon's experience and technique Follow-up duration Any pre-existing medical conditions or developmental factors affecting recovery

10. Methodology 1 ST STEP : permission will be taken from ethical committee. 2 nd STEP : Paediatric patients (age less than 14 yrs ) presenting to Orthopaedic Department who have sustained forearm fractures and have undergone elastic intramedullary nailing confirmed on X-ray AP and Lateral view will be considered. 3 rd STEP: Detailed history will be taken on demographics, mechanism of injury, date of injury, and proper X-rays of forearm will be taken in AP and lateral views. 4 th STEP: Appropriate data will be taken of the cases. According to the type and displacement of the fracture decision for Closed reduction with elastic intramedullary nailing will be taken.  5 th STEP: Post operative follow ups at 2 weeks, 4 weeks , 8 weeks with post operative X-rays and assessing range of motion will be taken to see the mean time of fracture union or any other complications .  6th STEP: Functional outcomes will be assessed after according to price and Flynn criteria 7 step : data will be entered in excel sheet and will be presented in number and percentage

11. Functional outcomes According to Price and Flynn criteria :  

12. 1: Upasani VV, Li Y. Elastic Intramedullary Nailing of Pediatric Both-Bone Forearm Fractures. JBJS Essent Surg Tech. 2020 Dec 24;10(4):e19.00055. doi : 10.2106/JBJS.ST.19.00055. PMID: 34055471; PMCID: PMC8154395. 2: Furlan D, Pogorelić Z, Biočić M, Jurić I, Budimir D, Todorić J, Šušnjar T, Todorić D, Meštrović J, Milunović KP. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scand J Surg. 2011;100(3):208-15. doi : 10.1177/145749691110000313. PMID: 22108751. 3: Demirtaş İ, Asfuroğlu ZM, Çolak M. Technical aspects that may affect the outcomes of pediatric patients with both-bone forearm diaphyseal fractures treated using elastic stable intramedullary nails. J Pediatr Orthop B. 2024 Mar 1;33(2):178-183. doi : 10.1097/BPB.0000000000001093. Epub 2023 May 29. PMID: 37266956. REFERENCE