ABSTRACT
Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

ABSTRACT
The term congenital pseudo-arthrosis of the tibia is a misnomer, as it is usually not present at birth but clinically manifest within the first decade of life. It is nonetheless a rare disease with yet a poorly understood natural history having varying presentations, which possess a great challenge of both diagnosis and management. It is however, a documented fact that 50% of these patients have neurofibromatosis type 1 and thus, a careful study and understanding of this condition as it present in patients with neurofibromatosis type 1 will also expose more about the disease entity itself, aid clinicians in making early diagnosis and tailor down a definitive treatment scheme which will help in limb salvage and prevent subsequent limb amputations amongst other complications. Here, we present a case series of two patients each with features of neurofibromatosis type 1, presenting with pseudo-arthrosis of the tibia. First patient is a 14-year old girl who presented with right leg deformity, multiple skin freckles and café au lait macula lesions on the body. Lower limb deformity was noticed since patient was 6-years of age following a minor fall at home, she has had multiple trial of local splinting of the limb and conservative non-surgical management of the limb deformity/fracture also in a peripheral hospital which has also failed and the deformity has persisted since then, she subsequently develops freckles which was noticed initially from the hand and progresses to cover the whole body including the palms and sole of the foot. On examination, she was stunted for age, not in any distress, anicteric not pale, with freckles covering the whole body, and macula café au lait spots around the upper back and thoracic region. There is an obvious deformity of the right leg, pseudo-arthrosis above the ankle joint and the right foot is under developed compared to the left foot. The second patient is a 4-year old.