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Surgical Management of Paediatric Diaphyseal Long Bone Fractures using TENS-An Institutional Experience

Prasanna Anaberu, Madhan Jeyaraman, Kartavya Chaudhari, Ajay SS1, Likhith D and Preethi Selvaraj

Background: Children are at a high risk of injury with up to one of every four children sustaining an injury annually. A positive approach to patient care by the treating Orthopaedic surgeon should be done to improve the functional quality of patient’s life. Due to the evolution of surgical implants, there is a paradigm shift over to internal fixation and early mobilization, with a return to normal function as early as possible.

Objectives: To prospectively review the efficacy, the functional outcome and the complications of TENS nailing in pediatric diaphyseal long bone fractures.

Materials and Methods: After the screening of patients, a total of 229 cases, which were enrolled in the study, were subjected for surgical management with TENS nailing. All the patients were followed up clinically and radiologically at the immediate post-op period and at the end of 1, 3, 6, 12 and 18 months. The efficacy and functional outcome of TENS nailing were charted according to DASH, Mayo’s wrist, Harris Hip score, and Lysholm scores. The ranges of movements were documented with Flynn’s criteria. All patients were offered with surgical implant removal at an average of 18 months post-surgical procedure that showed fracture union.

Results: Out of 229 cases, 140 cases were males and 89 cases were females with fall while playing followed by fall from a height being the most common mode of injury. The pattern of fractures was transverse in 109 cases, spiral in 53 cases, and oblique in 31 cases and comminute in 36 cases. All cases showed the union of fracture with an average of 13.37 ± 1.35 weeks. The functional range of movements (n=229) according to Flynn’s criteria were excellent in 179 cases, good in 37 cases and poor in 13 cases. The most common complication encountered in this study was pain, superficial infection at the nail insertion site, followed by malunion, non-union, nail migration, and malalignment. Implant removal was done under loco-regional anesthesia in an average of 17.32 ± 3.49 months.

Conclusion: TENS is the ideal device for the treatment of pediatric diaphyseal long bone fractures, which is a load sharing internal splint that allows mobilization and maintenance of alignment and extremity length until bridging callus forms.