Background:. In recent times there has been an increasing trend towards surgical intervention in paediatric femoral shaft fractures with widening indications. Titanium elastic nails and external fixation are two widely practiced procedures for such fractures. Materials & Methods:. We report a series of 48 children with 52 fractured femurs, 18 being managed by TENS and 34 in a linear external fixator. Children were aged between 3.5 to 12 years and the fractures were stabilised after an optimal closed reduction on a normal theatre table under image intensifier control. Fracture site distribution was nearly uniform in both the groups. Though most children were assigned to any of the groups at random, external fixators were applied on many younger children and those having financial constraints. Results:. The average age of children in the TENS group was 7.4 years and the average fracture healing time was 9.4 weeks. In the ex-fix group the figures were 5.6 years and 8.6 weeks respectively. Fixators were removed when good callus formation was seen on at least three cortices; average fixator time was 7.5 weeks. Fracture callus formation was slower in TENS group. Soft-tissue irritation at the nail entry points was the commonest complication for the TENS whereas pin-track infection was problem in the ex-fix group. Conclusion:. Management of paediatric femoral shaft fractures has changed to include more interventions. Flexible or elastic nailing like the TENS is a versatile and popular technique, however stabilisation in an external fixator also produce comparable results. External-fixation is an easier, cheaper and shorter procedure, and a mini ex-fix becomes a convenient external splint for smaller children who can be more conveniently nursed. Moreover ex-fix removal is an office procedure without anaesthesia

Purpose of Study:. To review the outcome of paediatric patients with radius and ulna fractures treated with titanium elastic nails. Description of methods:. Paediatric patients with radius and ulna fractures who fulfilled the criteria for TENS nailing were used. The criteria included failed closed reduction, instability (>15°angulation, >5°rotation) and open fractures. The patients were treated with retrograde TENS nailing of the radius and ulna. The patients were followed up at a paediatric orthopaedic outpatient clinic at 1, 3, 6 and 12 weeks with a final visit at 6 months. Data was collected at every visit looking at range of motion (pronation and supination), clinical and radiological signs of union and complications. Summary of results:. Over a 16 month period, 214 paediatric patients with radius and ulna fractures were seen and managed. Eleven of these patients were treated with TENS nails. The average age of the patient was 8.3 years. The average time to union was 8.5 weeks. The average range of motion at 6 months was pronation of 80°and supination of 73°. Two patients developed a compartment syndrome in the immediate post-operative period and were treated with a fasciotomy and skin grafting. No other complications were noted. Conclusion:. TENS nailing of paediatric radius and ulna fractures in unstable, irreducible and open fractures is a good treatment modality with good, early union of fractures and acceptable range of motion. It provides an excellent alternative to plating these fractures

Background:. Displaced midshaft clavicle fractures unite well in children less than 12 years old, owing to their inherent ability to remodel bone. In adolescents, remodeling occurs less and deformity or shortening can result. Recent literature in adults shows improved outcomes of these fractures with operative treatment. It has been suggested that these results may translate to adolescents. Study Objective:. To assess the effectiveness of titanium elastic TEN nails in the treatment of displaced midshaft clavicle fractures in adolescents. Methods:. Adolescent patients (age 12 to 18) with closed displaced midshaft clavicle fractures, sustained between 2008 and 2014, were treated operatively by a single surgeon, who inserted a TEN nail in an unreamed fashion from the sternal end of the clavicle. Post-operatively, patients were immobilised in a sling for 6 weeks. The nail was removed routinely at 12 weeks. All patients were assessed by the surgeon at 24 weeks with regards to the radiological outcome, Constant shoulder score, scar quality and complications. Results:. Thirteen patients, 9 males and 4 females (mean age 14,2 years) were assessed. Eleven patients had complete union by 6 weeks and the remaining two by 12 weeks. The Constant score was graded below 11 for all patients by 12 weeks follow up and all patients were satisfied with their scars after 24 weeks. Two patients developed complications: in one, the nail perforated the posterior cortex of the lateral fragment and the other developed a haematoma. Conclusion:. Operative treatment with a TEN nail is a safe, minimally invasive and reliable treatment method for displaced midshaft clavicle fractures in adolescents resulting in a satisfactory surgical outcome