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Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical & Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material & Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II & III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.

Cost-effective nursing practice is essential today as resources allocated to healthcare are declining. It is imperative that frontline staff and clinicians be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas aimed at achieving cost-effective practices should be encouraged. Intensive care unit (ICU) staff should know the price of consumables they are using. It helps them to decide on cost-effective treatment and involves them in decision-making with the physicians, achieving savings at the unit level. While strategic health authorities and the Department of Health are re-structuring the NHS to make it more viable, in any particular unit, staff members can make their input by controlling costs at a micro level and this will contribute to savings in running costs. Staff should be involved in making their unit cost-effective and this will in turn help to make their trust a cost-effective organisation.