Revista de Chimie https://revistadechimie.ro https://doi.org/10.37358/Rev. Chim.1949 Rev. Chim., 71 (5), 2020, 409-413 409 https://doi.org/10.37358/RC.20.5.8151 Osteosynthesis in Children with Titanium Elastic Nails in Ipsilateral Lower Limb Fractures MARIA DANIELA TRAILESCU 1,2# , BOGDAN SOCEA 3,4 *, NICOLAE GHEORGHIU 3,5 , DIANA GHEORGHIU 4 , MIHAI DIMITRIU 3,4 , NICOLAE BACALBASA 3,6 , IRINA PACU 3,4 , CATALIN CIRSTOVEANU 3,7# , ADRIAN IONEL PAVEL 1,2# , MIRCEA ALEXANDRU POP 1# , CRISTIAN GEORGE FURAU 1# 1 Vasile Goldis Western University Arad, Faculty of Medicine, Surgery and Pediatric Orthopedics Department, 86 Liviu Rebreanu Str., 310414, Arad, Romania 2 Surgery and Pediatric Orthopedics Department, County Clinical Emergency Hospital, 2 -4 Andreny Karoly Str., 310037, Arad, Romania 3 Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021, Bucharest, Romania 4 Sf. Pantelimon Emergency Clinical Hospital, 340-342 Soseaua Pantelimon, 021659, Bucharest, Romania 5 Elias Emergency Hospital 17 Marasti Str., 011461, Bucharest, Romania 6 Dr. Ion Cantacuzino Clinical Hospital, 5-7 Ion Movila Str., 020475, Bucharest, Romania 7 Maria Sklodowska Curie Emergency Clinical Pediatric Hospital, 20 Constantin Brancoveanu Str., 041451, Bucharest, Romania Abstract. Although we often find isolated lower limb fractures of the femur or tibia in children, ipsilateral fracture of both femur and tibia is a rarity among the pediatric population. The ipsilateral limb fracture is a rare event even in the adult patient population. The mechanism involved is most often one with high energy. The issue for pediatric surgeons and orthopedic pediatric surgeon remains relevant, as reported by this clinical case, due to the optimal orthopedic treatment of pediatric patients in this cases undefined. The interest arises from it being a clinical case involving ipsilateral fracture of femur, tibia and fibula associated with multisystem trauma sustained by the child. Titanium seems to be the ideal osteosynthesis material, especially in children with polytrauma, considering its chemical biocompatibility properties (being an inert material) and physical, its elasticity. Keywords: ipsilateral fractures, child, minimally invasive osteosynthesis, titanium elastic nails 1. Introduction Patients presenting multiple injuries, including multiple fractures of long bones are candidates for general complications that are responsible of high morbidity and mortality [1]. The optimal timing and orthopedic approach for long bones fractures in polytrauma patients remain a challenge [2]. According to damage control orthopedics, the hemodynamic stability of the patient must be initially ensured and only then the orthopedic correction treatment must be applied [3]. The ipsilateral limb multiple fractures in children, although rare, remain a challenge for orthopedists, given the ways to technically solve them, as well as possible postoperative complications, early or late [4]. Regarding long bone osteosynthesis in children, the therapeutic attitude is still controversial. In children, for femoral and concomitant tibial shaft fractures, cast immobilization remains a safe, cheap and effective treatment [5], but in the presence of ipsilateral fractures with displacement, on the lower limb, requires a different approach [6]. In addition, the need for prolonged extension and immobilization, the presence of superficial skin lesions in the lower limb, the risk of displacement during orthopedic treatment impose a particular orthopedic approach in this case. The options of treatment for femoral and tibial shaft fracture remain controversial for orthopedics. In these conditions, the types of fractures rarely encountered in current practice represents an important practical interest, which became the reason for publishing our case report. The purpose of our study is to show applicability and superiority of osteosynthesis with titanium elastic nails in the ipsilateral fracture of the left lower limb in the case of a 7-year-old girl. *email: bogdansocea@gmail.com # All the authors equally contributed to this manuscript and share first authorship