SURGICAL OUTCOME OF FOREARM FRACTURES TREATED WITH TITANIUM ELASTIC NAILING SYSTEM (TENS)

Abstract

Background:

Forearm fractures are the most common fracture in adults due to high energy road traffic accidents (RTA), fall injury and sports related injury. Open reduction and plate osteosynthesis is the gold standard treatment of forearm bone fracture. Closed surgical procedure with titanium elastic nailing system (TENS) has advantages of minimal tissue dissection, shorter operative time, rapid union, excellent recovery of range of motion and better cosmetic outcome compared to ORIF with plating. This longitudinal study was intended to evaluate the surgical outcome of adults forearm fractures treated with TENS.

Methods:

This hospital-based, longitudinal, observational study was conducted in Department of Orthopaedics UCMS-TH from December 2018 to April 2020. After ethical clearance (UCMS/IRC/205/18) from Institutional Review Board (IRB) of UCMS-TH and informed written consent, all patients with forearm fractures who fulfilled the inclusion criteria were enrolled in this study and treated with TENS. Post operatively the patients were followed at 6wks, 3months, and 6months for clinical, radiological and functional assessment as per Grace and Eversman Scoring System. Descriptive statistics like frequency, percentage, mean and standard deviations were used to analyze the data and association between different variables was assessed by Chi-square test and paired t-test. P-value <0.05 was accepted as statistically significant.

Results:

In this study of 120 cases, the mean age was 29.53±10.598 years. RTA was the most common mode of injury (76.7%). Most of the cases were of right side (73.3%) and AO/OTA Type A (56.7%). The majority of cases (43.33%) were operated within first day of trauma. The mean duration of surgery was 58.67 ±13.767 minutes and mean duration of hospital stay was 2.60±0.77days. The mean duration of union was 8 weeks. The most common post op complication was skin irritation at entry site (66.7%). There was no any significant major complication. The functional outcome evaluated according to Grace and Eversman Scoring System at the end of 6 months found good result in 46.67%, Excellent in 30% and Fair in 23.33%. Pain assessment by VAS score in each follow up 6wks, 3months and 6 months significantly decreased. The paired T-test showed the mean difference was statistically significant (p<0.005). The association between Type A and Type B fracture was found to be statistically significant in terms with fracture union, duration of surgery and duration of hospital stay (p<0.005).

Conclusions:

Titanium elastic nailing system (TENS) has good functional and radiological outcome. Being minimally invasive, preservation of fracture hematoma, no periosteal stripping, minimal operative time and duration of hospital stay, less chance of refracture during implant removal it can adopted as an alternative to ORIF with plate osteosynthesis in treating adults forearm fracture.

Keywords:

Forearm, fracture, TENS, Functional Outcome