Elastic Stable Intramedullary Nailing (ESIN) Provides Good Long-Term Results in Pediatric Long-Bone Fractures

Abstract

The present study evaluates the long-term outcome of elastic stable intramedullary nailing (ESIN) in children with long-bone shaft fractures. 70 patients were examined, the present mean age of patients was 12.7 (± 3.26) years, mean time interval since surgery was 3.1 (± 1.49) years. Following ESIN at the lower extremity (23 femur fractures, 14 tibia fractures), keloid formation was remarkable in one patient, range of motion (ROM) was adequate in all but one boy (extension deficit of the hip of 10°). Overall leg length discrepancy was + 4.1 mm (± 5.2 mm) following ESIN for femur fracture and + 3.2 mm (± 6.4 mm) following tibia fracture. Radiologically, all fractures had healed and no signs of avascular necrosis (AVN) could be detected. Malalignment was documented in one girl following tibia fracture (valgus of 12°). Assessment of the upper extremity (28 forearm fractures, 5 humerus fractures) revealed keloid formation in 5 children. Impaired ROM was found in three children following ESIN for a forearm fracture (limited pro-fsupination). Radiological controls detected one case of retrocurvation of the humerus (12°, polytrauma patient) and one varus deviation of the radius in a 10-year old boy. Questioning the children about their opinion of the treatment, 93 % considered the cosmetic results as good (6% fair), they judged the functional ability as perfect in 91 % (9% fair) and 93 % expressed great overall content (6% fair, 1% poor). In conclusion, ESIN provides good long-term results and can be a beneficial method for children with long-bone fractures.• Key words: Intramedullary nailing -Shaft fractures -Children -Long-term results ResumeL'Hude evalue le devenir along terme de I'enclouage elastique stable chez les enfants presentant des fractures des os longs. Soixante-dix patients ont ete examines. L'age moyen des patients Hait de 12,5 (± 3,26 ans). Le delai moyen depuis la chirurgie etait de 3,1 (± 1,49) ans. Suivant I'enclouage elastique stable a I'extremite inferieure (23 fractures femorales, 14 fracEur J Pediatr Surg 2000; 10: 319 -322 © Georg Thieme Verlag Stuttgart, New York . Masson Editeur Paris ISSN 0939-7248 ture tibiales) une formation chelo"ide etait remarquable chez un patient; la mobilite etait normale chez tous sauf un garc;on (deficit de I'extension de la hanche de 10°). Le raccourcissement du membre etait de 4,1 mm (± 5,2) apres I'enclouage medullaire elastique stable du femur et de 3,2 (± 6,4) apres les fractures du tibia. Radiologiquement, toutes les fractures ont cicatrise et ne presentaient aucun signe de necrose vasculaire. Un mauvais alignement Hait mis en evidence chez une fille apres une fracture du tibia (valgus de 12°). Le bilan au niveau de I'extremite superieure (28 fractures de I'avant-bras et 5 fractures de I'humerus) montrait une formation chelo"ide chez 5 enfants. Un defaut de mobilite etait trouve chez 3 enfants suivant I'enc10uage stable elastique pour une fracture de I'avant-bras (limitation de la prono-supination). Les contröles radiologiques mettaient en evidence 1 cas de retr...

Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children

“…During the last two decades, elastic stable intramedullary nailing (ESIN) has become the method of choice for internal fixation of femoral [2][3][4][5] and tibial shaft [6][7][8][9] fractures in children aged 4-14 years. However, in unstable fracture types of the lower limb, these implants may prove to be more elastic than stable, especially in patients older than 12 years, with higher body weight, and when combined with intraoperative technical difficulties [10,11].…”

Nancy nailing of diaphyseal forearm fractures

“…Previous authors have suggested that treatment with intramedullary fixation including elastic stable intramedullary nail (ESIN) fixation is satisfactory. [3][4][5][6][7] A number have reported the results of single bone plate fixation suggesting that it is not always necessary to plate both bones. [8][9][10] Our aim was to determine whether the principle of single forearm bone plate fixation could be applied to intramedullary fixation.…”

The Use of ESIN in Humerus Fractures

“…Anyway, ascending ESIN of the proximal humerus is not an operation for beginners! Only 10-20% of humeral fractures are fractures of the shaft [8,12]. This corresponds to 0.5% of all skeletal injuries.…”