The document presents a study protocol to evaluate outcomes of radius and ulna shaft fractures in adults treated with titanium elastic nailing. The study will assess range of motion, time to bone union, complications, and functional outcomes in 50 patients over 18-60 years old with displaced double forearm fractures treated with intramedullary nailing. A review of previous literature found that intramedullary nailing provides advantages like closed application and early return to movement for forearm fractures.

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Title the Thesis:“_A STUDYFOROUTCOMESOF RADIUSAND ULNA SHAFT FRACTURESIN ADULTS
TREATEDBYTITANIUMELASTIC NAILING SYSTEM.
By
Dr.Shlok.P.Mendiratta
Department of Orthopaedics
Assissted by
Dr.Vivek .A.Patel
Professor,Department of Orthopaedics
Gujarat Adani Institute of Medical Sciences
KSKV Kachchh University, Bhuj

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Introduction
• Forearmdiaphysealfracturesmustbe consideredasintraarticularfracturesdue totheirfunctionalandanatomicalcharacteristics.
• Insufficienttreatmentofforearmfracturesnegatively affectsnotonlythe forearmbutalsoentireupperextremityfunction[1].
• Therefore,in treatment,earlymobilizationis aimedwithproviding axialalignmentandrotationalstability[2].
• Thereisconsensuson applyingsurgical methodsin treatmentof forearmdiaphysealfractures[3,4]
• Today,theaccepted treatmentmethodisplateosteosynthesis.[5]

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• Plateosteosynthesishashigh bone unionratiosandprovides stablefixation.However, itrequiresextensive surgicalexposureand
periostealstrippingduring application[6,7].
• In recent years,newintramedullarynaildesigns havebeen startedtobewidely used in surgicaltreatmentof forearmstructures[1,3,4,8-10].
Intramedullarynail methodhasadvantagessuch asclosed application,less softtissue injury,cosmetic advantagesandproviding rotational
stabilitywithits locking feature[3,4].
• Theaimof ourstudywastoevaluate theresults ofnew designintramedullaryradiusandulnanailsin surgicaltreatmentofadultdisplaced
forearmdoublefractures.

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Aim & Objectives
• AIM:
• TOSTUDYTHEOUTCOMESOF RADIUSANDULNASHAFT FRACTURESINADULTSTREATEDBY TENS.
• OBJECTIVE
• TOEVALUATETHERESULTSINMOVEMENTS,FRACTUREHEALINGANDCOMPLICATIONINPATIENTSWHOHAVE UNDERGONEINTRAMEDULLARY
TENSNAILTREATMENTINADULTDIAPHYSEALRADIALANDULNARSHAFT FRACTURES.

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Reviewof Literature:
• In2018,articleby Ahmetkose and Ali aydun aimedto evaluatethe results of intramedullarynail treatment in surgical treatment of adult displaced radius and
ulna diaphyseal fractures.
• Eighteen patients (36 forearm fractures) who underwent intramedullary nailtreatment dueto radius and ulna fractureswereretrospectively analyzed.
• Adult patients with displaced forearm double fractureswereincluded in this study. Patients with open physeal lines, pathological fractures, Monteggia and
Galeazzi fractures, distal radioulnar joint instability, bilateral fracturesand bone loss were excluded.
• Results Thirteen patients were male (72.2 %) and five were female (27.8%). Average age of the patients was 35.16(18–63).
• Twelve patients (66.7%Average follow-up period was 77.7(55–162)weeks, average bleeding amountwas 51.11(15–100)ml, average time to bone union
was 11.3(8–20) weeks, average surgerytime was 61.94(45–80)min and average fluoroscopy time was approximately 2 (1–5) min.
• Accordingto Grace-Eversman criteria, results were excellent in 14(77.8%) patients, good in 3(16.8%) and acceptable in 1(5.6%).
• Average DASH questionnaire score was 15.15(4–38.8).Therewas no iatrogenic vascular, neuraland bone injuryduring surgery.Therewas late ruptureof
extensor pollicis longus tendon in 1patient 4months after surgery.

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.Conclusion that Intramedullary fixation method has advantages, such as closed application, short surgeryperiod, good
cosmetic results and early return to movement.
. Wethink intramedullary fixation method may beused as an alternative treatment method to plate osteosynthesis in
surgical treatment of radius and ulna diaphyseal fractures.

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Methodology
• Samplesize:50Informedconsentswill be takenfromall patients.
• StandardforearmAnteroposteriorandlateralradiographswill betakenatfirstadmissiontohospital.
• AO Systemwill beused forclassificationofFractures.
• PostopAnteroposteriorandLateralradiographswll be taken.showingtens Nailin radiusandUlna.
• PrimaryoutcomeincludesRangeofsupination,pronationatwristandflexion,extensionatelbowwill beevaluated.ThedetailsofROMof
forearmwith elbowflexedat90*will bemeasuredby goniometer.
• Handgripstrengthofpatientswll beevaluated.
• SecondaryOutcomeincludestimetoachieve boneunion andfunctionalquestionnairetoevaluatethe functionofdiseased limb at1,3,and6
monthspostoperatively.
• Analysiswill be doneusing excel sheet using descriptiveanalyticalandstatisticaltools

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Inclusion-Exclusioncriteria
• InclusionCriteria
• 1.Patients above 18and below 60 yrs
• 2.Patients undergoing TEN(Titanium Elastic Nail)surgery in both radius-ulna displaced fracture
• Exclusioncriteria
• Patientshaving
• 1.Pathological fractures
• 2.Monteggia,galeazzifractures
• 3.Distalradio-ulnarjointinstabilities
• 4.Neurovascularinjuryatfirstpresentation
• 5.Singleforearmbonefractures
• 6.Patientsrefusing togiveconsent
• 7.PolytraumaPatients

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Data Analysis
• Data will be collected,tabulated.Data will berecordedas percentage,arthimatic mean andstandard deviation. Bone
union will beevaluated accordingto AP and lateral views taken during follow up.
• Patients’ wrist, forearm and elbow joint rangeof motions will bemeasuredwith goniometer.
• Functional evaluation was performedaccordingto Grace- Eversmanevaluation criteria and DASH (Disabilities of
the Arm,Shoulder, and Hand) Criteria.
• P value<0.05 will beconsidered as significant in the evaluation of results.

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Feasibility
• Stacked nailingis a good option in midshafttransverse or short oblique fractures of
radius and ulna.
• It allows early mobilization withoutbrace or splint
• .Withproper patient selection,good results can be obtained by minimallyinvasive
method.
• Therefore, in treatment,early mobilizationis aimed with providing axial alignmentand
rotational stability.

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References
.1.Crenshaw AH Jr(2013)Fracturesof shoulder, arm and forearm. In: CanaleST, DaughertyK, JonesL (eds) Campbell’s operative orthopaedics, 10th edn. Mosby,
St. Louis, pp 3049–3058
• 2. Schemitsch EH, Richards RR (1992)Theeffect of malunion onfunctional outcome after plate fixation of fracturesof both bones of the forearm in adults. J
Bone Joint SurgAm 74:1068–1078
• 3. Gao H, Luo CF, Zhang CQet al (2005)Internalfixation of diaphyseal fracturesof the forearm byinterlocking intramedullarynail: short-term results in
eighteen patients. J Orthop Trauma19:384–391
• 4.Lee YH, Lee SK, ChungMSet al (2008)Interlockingcontoured intramedullary nailfixation for selected diaphyseal fracturesof the forearm in adults. J Bone
JointSurg Am 90:1891–1898
• 5. Rehman S, Sokunbi G (2010)Intramedullary fixation of forearmfractures. Hand Clin 26(3):391–401
• 6.Jones DB Jr,KakarS(2011)Adult diaphyseal forearm fractures: intramedullarynail versus plate fixation. J Hand Surg Am 36(7):1216–1219.
• 7. Langkamer VG, AckroydCE(1991)Internalfixation of the forearm fracturesin the 1980s:lessons to be learnt. Injury22:97–102

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8. Saka G, Saglam N,Kurtulmus¸ T et al (2014)New interlocking intramedullaryradius andulna nails for treating
forearm diaphyseal fractures inadults: a retrospective study. Injury45(Suppl 1):S16–S23
9. Schemitsch EH, JonesD, Henley MB etal (1995)A comparison of malreduction after plate and intramedullary nail
fixation of forearmfractures. J Orthop Trauma9:8–16
10. Sage FP, SmithH (1957)Medullary fixation of forearm fractures. J Bone Joint SurgAm 39-A(1):91–98.

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