15yrs 4months tall well built male presented with grossly displaced closed middle 1/3rd fracture right tibia and fibula without dnvd.closed reduction was attempted on table but due to soft tissue interposition and overriding of fragments failed. Indirect technique using bone levers used and fragments were unlocked by percutaneous technique.never had such tough time on table to reduce any fracture.crif with multiple TENS nailing done as diameter of canal for his age group was quite wide.4mm TENS 4nails were inserted .patient is protected with anove knee slab for 4weeks.
Alhamwi Talal Why not nailing?????
I don't know Why u chose this option ??????
By nailing you can achive better reduction for sure
- Rahul B Tanga Alhamwi Talal he is 15 and physis an TT still not closed bit risky doing regular nail.i have seen few cases going for revurvatum knee where nailing was done.so better avoid. He is 99 born and not even completed 15technically.i have done nailing in around 17 age group.
- Alhamwi Talal It's almost close man and in this age remodling is bad
I would like nailing or plate if not 
Ashwini Sood Y so much unrequired stress on close procedure ?
I have done good number of such cases by open plating.
Anything against it ?- Rahul B Tanga Muhammad Haseeb i had kept both on table but again after chrcking knee right and left oblique views which confirmed physis and TT was still open so went ahead with TENS 4MM each 4 in number and canal was quite wide.
Alind Kishore Singh good for the age..sir did you burry the tip of the nails? Two tens nail with slab would have been enough..good work..reason for choosing proximal n distal entry points??
Ahsan Choudhary i do plating( may be with lag screw) if fracture closed
Rami Hussein These fractures can be very difficult to reduce, I have opened them in the past and done flexible nailing. Well done
Rustom Adi Mody These tens nails will work perfectly. Advantage over plating will be removal on a day care admission. Correct choice of implant.
Mohanraj Sadasivam U could have opened fracture site instead of so much struggle sir.. and given a plate.. correct if wrong- Ashwini Sood I think Dr Rahul B Tanga
point should be taking here ,
as evidenced by so many surgeons....Ver más - Rahul B Tanga Ashwini sood sir.i get cases where most of them are complex or complicated so used to work under stress.so at times its worth giving good try.
- Rahul B Tanga Ujgar singh sir trust me i havent plated a single tibia in this age group till date and no personal experience.
- Rahul B Tanga At times i wonder when i do open reduction and plating then people ask why not mippo.now closed nailing done in adolescent with good efforts which is quite acveptable and will get decent results and i have been asked by many members why not orif with dcp. I am confused now😴😴😴😴😴
- Alind Kishore Singh Don't worry sir its the end result and patient wellness is what we want..union is not a problem in this age..so we should prefer elastic nail over plate...I have a series of cases in adult both bones fracture managaed with tens nd healed...without any 2nd surgery...
Ajay Pal Singh Kanwar We usually are following foriegn texts and studies and its only four to five years that orthopedics is seen as evidence based in india. This group is at least a step in this direction. post xray after callus formation. no matter what is the implant we d vouch for union n function...
- Rahul B Tanga Thanks Abdelrahman Eldiasty .sorry i overlooked.there is no payella alta i saw on table.
Anand Merh In this age group what you have done is the most appropriate procedure Rahul. I don't understand why people are so crazy about plating a tender bone!! Learning so many newer concepts!!!!!!!!!!!
- Ujagar Singh Rahul, I didn't ask to confuse you but wanted to know your opinion regarding dcp and if you didn't do plating there must be some reason against it....
- Rahul B Tanga Ujgar singh sir i havent done plating till date in this age group.since the day one of my dnb i have been exposed for TENS nailing and never seen anyone doing dcp in those days so i have cultivated the same..
Jay Sharma This is perfect .. A query .. Can u put Enders as we have stalked the canal .. Instead of tens .. Cost !
Shah Nisar Yes u r rite Rahul B Tanga
Had u gone for plating, people wd hv questiond about age mippo implant removal infection!!!!! Great job
Arvind Jain yes..I have seen this difficulty,a well built calf and leg doesn't allow to hold a good grip even.- Rahul B Tanga Alind Kishore Singh both nails have same level entry point but medial nail was trimmed and lateral was left
Rishi Sanghavi Sir. I have came across this for twice. Both pediatric and both middle shaft with 2 to 3 day old injury. I had done open reduction 3.5mm two TEN nail in both. After unlocking it locks in reduction so well that its like insitu nailing. It do not displac...Ver más- Rishi Sanghavi I will advise open reduction instead of mipo. And i always put tens in ped patients. I vl not do plates. Not exposed with plating in middle tibia fractures. 2nd thing axial load is allowing better callus in nails. So after opening ur draing frac hematoma which is vital for healing. Here u nail it allow ptb walkin and it unites.
- Ashwini Sood Dr Rahul B Tanga and other respectable collegues.....
Thanks for your input.It was as usual a very lively discussion.
As far as I am concerned I want to give my own 10 paise input......Ver más 
Balakannan Jayabalan Good one. Experienced similar cases.will have no problem
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