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fractur of femur shaft and healing timeline in 7 year old child.

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August 13th, 2011
HI,
MY SON, 7yrs, HAD AN ACCIDENT ON 3RD JUNE 2011. AND HIS RIGHT FEMUR SHAFT WAS FRACTURED. He was on traction till 19th June, 2011 since there was no reduction in the fracture site. he was operated and two titeneum elastic nails 4mm were inserted inside his femur from the knee sides (both side. today he had compeleted 54 days post surgery, his knee was very stiff but now he is able to bend his knee to a good extent. He is also able to walk with support of walker with partial weight bearing. i had the following quary please answer:
1. Exactly how long does it take to join femur 100%.
2. at this stage shall we alow him to walk on full weight bearing.
3. It is very dificult to make him still, since children are moving too much, does if will effact the positioning of healing?
4. we had taken a x-ray on 25th july, which says healed scars with peri-ostial groth arround the site. when we see the x-ray from AP view it looks that the bone is joined nicely. but when we see it on lateral view we see the gaps and miner displacement. is it normal? his surgeon said that the miner displacement at lateral view is a normal and you will see it even after 1 year to but the bone will join like an envelop.
5. when we should send him to school? as he will be completing 2 months on 20th august, 2011.

sorry for asking so many questions. please answer earliest.
regards

SANJAY
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First Helper User Profile Gaelic
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Gaelic
replied August 17th, 2011
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sanjaysingh,

In a study done on pediatric patients under the age of 14, with femur fractures, treated with Enders nails, all fractures healed within 12 weeks. So, that is a pretty good guideline.

Since children still have open growth plates and a lot of growth potential, they can remodel fractures significantly. So, even a displacement of 100% will heal and remodel in a 7 year old. The only deformity that will not remodel is rotation. But, displacement and angulation are easily remodeled by young children.

Knee range of motion is often decreased in femur fractures, because the muscle of the thigh are also damaged at the time of the break in the bone. Muscles heal with scar tissue, which does not stretch very well, and the healing tissue can scar the muscle down to the bone, not allowing it to slide. So, it is very common for the quad muscles to not allow the knee to bend very well. It is very important for these muscles to be stretched.

As to how much weight bearing should be allowed, that is up to the treating surgeon. He/she is the one who knows how stable the fracture construct and implanted hardware are, so you should contact the surgeon and ask this question of him/her. Same with the question about going to school.

Hope your son is doing well. Good luck.
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sanntiblr
replied August 24th, 2011
Thanks and i appriciate your reply.
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sanntiblr
replied January 2nd, 2012
Dear sir,

Please refer my email dated august 13th, 2011. Now my son had completed 6 months after operation with enders nail. He has become 100% normal and able to walk and sit like before, except he had put on some weight.kindly advise what is the appropriate time to remove the enders nails as the treating doctor said it can be removed anytime within one year,
please advise.

with best regards

sanjay singh
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Gaelic
replied January 2nd, 2012
Especially eHealthy
sanntiblr,

The originators of the technique (Drs Ender and Simon-Weidner) recommended removal of the nails at about six months. However, at least one author (Dr Narayanan) has questioned the necessity of removal of the nails at all in the absence of symptoms in the child. But, most pediatric orthopedic surgeons would recommend that the nails be removed within one year.

So, it is basically up to you and your surgeon. But, it sounds like your surgeon in right on track. It is a surgical procedure to have the nails removed, but a lot easier than having them put in. Your son would be able to begin weight bearing as soon as tolerated. So, the recovery period is much shorter.

Glad to hear that your son is doing so well.


Barry M, Paterson JMH. ASPECTS OF CURRENT MANAGEMENT: Flexible intramedullary nails for fractures in children. The Journal of Bone and Joint Surgery VOL. 86-B, No. 7, Sept 2004

Enders J, Simon-Weidner R. Die fixierung der trochanteren bruche mit runden
elastischen condylennageln. Acta Chir Austr 1970;2-40.

Narayanan UG. Elastic stable (flexible) intramedullary nailing of paeditric femoral
fractures. COA Bulletin 2003.
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sanntiblr
replied January 2nd, 2012
Thanks Dr Gaelic,

I sincerely thank for your prompt reply sir, your reply had given me a clear picture about the topic. Thursday i am taking him for a follow-up checkup lets see the actual situation and advise of treating doctor. i will put his x-ray picture, to seek your advise too before we remove his nails.

once again thanks and HAPPY NEW YOU TO YOU AND YOUR FAMILY.

regards
SANJAY SINGH
BANGALORE, KARNATAKA, INDIA
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sanntiblr
replied May 14th, 2012
Thanks Dr Gaelic,

In continuation of my earlies post. My son underwent surgery to remove the enders nail on 18th of February, 2012 almost 8 month after its fixation. As the doctor was advising us to go for removal. He advised him for not to do weight bearing till 3-4 week. from march 3rd week my son became normal like before except slight knee bending issue. We were giving him knee bending and quarderceps exercise daily since then. Now he is normal. He can play badminton by slightly moving his body left and right side.

now his school wil be starting from 21st may, will it be advisable to send him school. As his class room is at 2nd floor. He is able to climb my appartment at first foor. kindly advise it is o.k. to send him school?? He can carry his school bag or not?? any precaution to be taken ??
Being a father i m very curious to know all that.
sincerely thanking you for all you advise
with best regards


SANJAY SINGH
BANGALORE, KARNATAKA, INDIA
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sanntiblr
replied May 19th, 2012
In continuation of my earlies post. My son underwent surgery to remove the enders nail on 18th of February, 2012 almost 8 month after its fixation. As the doctor was advising us to go for removal. He advised him for not to do weight bearing till 3-4 week. from march 3rd week my son became normal like before except slight knee bending issue. We were giving him knee bending and quarderceps exercise daily since then. Now he is normal. He can play badminton by slightly moving his body left and right side.

now his school wil be starting from 21st may, will it be advisable to send him school. As his class room is at 2nd floor. He is able to climb my appartment at first foor. kindly advise it is o.k. to send him school?? He can carry his school bag or not?? any precaution to be taken ??
Being a father i m very curious to know all that.
sincerely thanking you for all you advise
with best regards


SANJAY SINGH
BANGALORE, KARNATAKA, INDIA
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