الفهرس 
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Abstract
Our present study was conducted in the department of Orthopedics, Sohag university hospital, Sohag University during the period between July 2015 to April 2016.
Twenty patients of tibial shaft fractures simple& open types I&II managed operatively by internal fixation with flexible intramedullary nail during the course of the study were sorted and each was followed for at least 6-9 months.
Follow up of all patients in both groups were carried out regularly with clinical and radiological assessment till 9 months postoperatively. The data thus collected from patients was analyzed, evaluated, compared with each other and the observations were recorded.
Our aim was to assess the usefulness of using the flexible intramedullary nail in treatment of tibial shaft fractures in adolescents.
The primary outcome was to measure are time to full weight bearing , time of union , bone alignment , functional results and complication rate like deep infections, non-union and malunion.
All the patients were examined clinically and radiological, including detail history of pre morbid status at the time of admission. Patients fulfilling the inclusion criteria was only included in the study.
Internal fixation for tibial shaft fractures with flexible intramedullary nail is considerd a safe and effective method for the treatment of most tibial fractures in adolescents.
This provides stable fixation with minimal violation of the soft tissue envelope.
With excellent functional out comes & minimal complication rates.
In case of small diameters of inserted nails relative to size of the medulla ,Varus and valgus deformities occurs with fractures of the distal third tibial fractures.
To overcome this problem and improve outcome, we recommend the use of large diameters of the inserted nails (4.0mm-4.5mm).
Healing within a reasonable period of time. The complication rate was considered minimal. Only one case of non-union, with residual malalignment of less than
5°.
Careful follow up of the patients is recommended. This technique confirmed by our results minimizes the complication rate of malalignment & infections and facilitates early return to normal activities of the patient.
Mean age in years for this study is 14 years; there was a male preponderance in our patients. A male to female ratio in all patients was about 2:1.
Most common mode of injury in adolescent patients, are falling from height and road traffic accidents.
All the patients in present study series were operated within 24 hours following admission in hospital.
In our study Pre-operative morbidity & postoperative mortality were zero.
No cases of infections seen in our study.
No implant related intra operative complications were noted in our study. Varus deformity was noted in one case (5%).
Two cases were associated with fracture mid shaft radius & fracture distal shaft femur
Internal fixation was done in the same operation.
Average time of fracture union: Average time of union in all our 20 patients was about
12weeks. (Range:10 to 14 weeks).
Average time of weight bearing: in all our 20patients time of weight bearing was about
6weeks (Range: 5 to10 weeks).
Range of Movement according to Olerud – Molander ankel score of 91 to 100 points was considered excellent; 61-90 points, good; 31-60 points, fair; and less than 31, poor The range of motion that is flexion, extension, abduction, internal and external rotations were good to excellent in most of the cases operated by flexible intra medullary nail.
CONCLUSION
In the present study which was carried out in Sohag university hospitals, faculty of medicine, Sohag university from July 2015 to April 2016.
Twenty patients with simple & open tibial shaft fractures type I&II according to Gustilo-Anderson were included.
In our study we aimed to evaluate whether these theoretical advantages could be proved in practice by evaluation of the results of internal fixation for these types of fractures by flexible intramedullary nail.
The management of tibial shaft fractures has always been a challenge to the surgeon, especially in comminuted fractures. The traditional surgical techniques aiming at anatomical reduction and rigid internal fixation has raised a lot of complications, probably due to soft tissues status and devitalization of the fracture fragments that renders healing markedly jeopardized.
The introduction of the concept of internal fixation aims to improve the chances of healing as it utilizes the importance of the soft tissue envelope and preserves the vitality of the involved bony segments.
Out of the 20 fractures managed by this method 19 fractures showed uncomplicated healing within a reasonable period of time. With excellent functional outcome.
The complication rate was considered minimal. Only one case of non-union with valgus angulation of about 5° due to small diameter of the flexible intramedullary nail relative to size of the medulla.
We recommend that this method could be used in the management of simple & open tibial shaft fractures types I&II in adolescents.
However .the procedure is technically simple, requiring the availability of appropriate tools and surgical implants, Careful follow up of the patients is recommended. This technique confirmed by our results minimizes the complication rate and facilitates early return to normal activities of the patient with excellent functional out comes. Achieving a good quality reduction at the level of the bone segment should be the objective for anatomical axis restoration.