5yr old child with displaced femur fracture treated with TENS. Critical comments please to improve.
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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..
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Jahangeer Basha Shaik niceno need to bend the ends. it will cause irritation one they start movement.
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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
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Natraj Hm Its not there in my mobile; tomorrow I’ll post the preop xray.. Fracture was fully displaced
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Jahangeer Basha Shaik nice. no need to bend the ends. it will cause irritation once they start movement at entry site
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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
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Natraj Hm Accepted Dr rudra narayan pandey.. 2nd nail was not passing in freely so bit smaller size was used
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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…
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Yugandhar Popa well done doc, distraction can be avoided by simply thumping the bent knee, or straight limb, try these next time…
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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…
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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
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Natraj Hm I used this formula..Size of each nail= (canal diameter/2) -0.5mm
This is the formula.. 40% is just apprpximation.. -
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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
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Pedro Jorba Hardly a comparable case; Natraj’s patient had an extremely short, transverse fracture, which would be much more unstable on conservative treatment
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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
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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% )))) -
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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
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Somnath Chowdhury ender’s nail is not an alternative for definitive fixation. it works on principles that no textbook recommends/advocates
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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.
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Natraj Hm Thank you gentle men for all the wonderful input.. Really a fruitful discussion.. Good night guys
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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