IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 9 Ser.6 (September. 2021), PP 34-37 www.iosrjournals.org DOI: 10.9790/0853-2009063437 www.iosrjournal.org 34 | Page Clinical Study of Ender's nails fixation in tibial shaft fracture in Paediatric patient Dr. Omprakash Kumar 1 , Dr. Vivekanand Kumar 2 , Dr. Niraj Kr. Choudhary 3 , Dr. Raju Kumar 4 , Dr. Abhimanyu Kumar 5 1. Associate Professor, Department of Orthopaedics, N.M.C.H, Patna 2. Senior Resident, Department of Orthopaedics, N.M.C.H, Patna 3. Junior Resident, Department of Orthopaedics, N.M.C.H, Patna 4. Junior Resident, Department of Orthopaedics, N.M.C.H, Patna 5. Junior Resident, Department of Orthopaedics, N.M.C.H, Patna Abstract Background and Aim: Displaced fractures of the tibial shaft in children can be effectively treated with minimal complication with flexible nails. Our aim is to evaluate the outcome of displaced paediatric tibia shalf fractures treated with Ender's nails. Material and Methods: This is a study of 24 patients of unstable tibial shaft fractures in children treated with Ender’s nailing. 20 were closed fractures & 4 were open grade one fractures with only punctured wounds. Eighteen patients had concomitant fibula fractures. In 20 patients tibia fracture was an isolated injury, one had associated same side clavicle fracture and one had associated same side lower end radius fracture. Results: Average time for fracture union was 9 weeks (range 6 to 15 weeks). All fractures united without 2nd operative intervention. Slight nail back out occurred in many patients, but only in 2 patients significant proximal migration of nails occurred causing some knee irritation, but not requiring any operative intervention before fracture union. In all patients implant removed 6 to 7 months after surgery. There was some restriction of knee movements in 4 patients in which nails were significantly backed out, but after implant removal full knee movements achieved in all patients there was full ankle movements in all patients at final follow-up. Conclusion: Based on our results, Ender’s nailing is an effective method of treatment in these cases, which allows rapid healing of tibial shaft fractures with an acceptable rate of complications. Keywords: Ender; Technique, Children, Tibial shaft, fracture, Flexiblenail, implant, tibia -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 28-08-2021 Date of Acceptance: 12-09-2021 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Fractures of the tibial shaft are important for the reason that they are common and controversial. The exposed anatomical location of the tibia makes it vulnerable to the direct blow and high energy trauma as a result of motor vehicle accidents, thus resulting in comminuted fractures which are frequently open with significant loss of skin and soft tissues. Because of the high prevalence of complications associated with these fractures, management often is difficult and the optimum method of treatment remains a subject of controversy. Flexible unreamed intramedullary nails have long been used to manage diaphyseal fractures of long bones. Enders nail (EN) is an unreamed intramedullary nail used for femoral shaft and intertrochanteric fractures; and now also for tibial shaft fractures. ENs allow early weight- bearing and can be placed with closed technique, which avoids damage to soft tissue and blood vessels. Reports in literature indicating adverse effects of reaming with increased incidence of pulmonary complications and disruption of vascular supply of inner 2/3rd of cortex, have resulted in increased popularity of unreamed nails for fixation of such fractures. These nails rely on three-point fixation in the medullary canal and provide favourable mechanical conditions, as the forces are evenly distributed along the entire length of nails. As the fixation by these nails is not rigid, therefore some amount of micro-motion occurs between the two fragments which in turn stimulate fracture healing. These nails do not ensure sufficient longitudinal stability in grossly comminuted or long oblique fractures with resultant shortening. . Many studies have supported the use of this technique in the femur, citing advantages thatinclude closed insertion, preservation of the fracture haematoma and a physeal sparing. entry point. Few studies have also described the use of flexible intramedullary nails in the tibia. But most of those studies are for titanium elastic nails. The purpose of our study was to present results of fixation of