Ender's Fracture Case Study

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1. To study lower third tibia fracture patterns.
2. To study the management of these fractures by Ender’s nailing and its functional outcome.
3. To study various complications in patients managed by Ender’s nailing
4. To set guidelines for management of these fractures.

Fractures have been recognized and treated as long as recorded history. History of fracture and its knowledge dates back to Egyptian mummies of 2700BC.

For thousands of years the only option for the management of fractures was some form of external splintage. 5000 years ago, the Egyptians used palm bark and linen bandages for management of fractures. Clay and lime mixed with
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The principles of treatment included:
1. Re-establishment of the fibular length
2. Re-construction of the lower articular surface of tibia
3. Placement of metaphyseal bone graft; and
4. Stabilization of the medical aspect of tibia using a plate.
Of the 84 fractures, 60 were secondary to low energy skiing injuries. 90% of the patients returned to their pre-injury occupations. 21

B) A series of 26 patients were divided into 2 groups based on fracture pattern. Type A fractures with twisting injuries with little comminution, whereas Type B fractures were more severe injuries, with a crush component. On treatment with open reduction and internal fixation, 65% cases had good to excellent results. Better results were obtained in Type A fractures (84%) than B (53%). Crucial factors besides fracture type were the length of immobilization and quality of reduction. Prolonged immobilization resulted in poor outcome, showing the need for stable fixation to permit early range of motion.
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This approach aims to pressure bone biology and minimize surgical soft tissue trauma. This provided 87.5% of good to excellent results. Fractures were classified according to the AO system and performed as scored stage surgery after sterilization with external fixators primarily. 29

H) In a study of 32 adult patients with very short metaphyseal fragments in fractures of distal treated with a polyaxial locking system. The polyaxial locking system shown results of 87.3 functional out come with American Orthopaedic Foot and Ankle Society score which offer more fixation versatility, may be a reasonable treatment option for distal tibia fracture with very short metaphyseal segments.30

I) A retrospective review of 22 patients with distal third tibial fractures were treated with titanium locking compression plates using minimally invasive technique good biological fixation of distal tibial. A total of 81% of good to excellent outcome was assessed using American Orthopaedic Foot and Ankle

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