Particular Applications of Elastic Stable Intramedullary Nailing (esin) for Femoral Fractures in Children

Over the past few years there has been a marked increase in the use of intramedullary fixation in the management of fractures of long bones in children. To some extend this reflects a more interventionist attitude among pediatric orthopedic surgeons but is also due to technical developments, notably that of the elastic stable intramedullary nail (ESIN). We used ESIN for several years for treating transverse or short oblique fractures of long bones in children. We proposed to analyze the utility of this method in treating complex fractures or pathological fractures (not malignant) in children and we reviewed our series of patients treated with ESIN and we found particular cases of femoral fractures treated with ESIN. We analyzed for these patients the type of fracture, age, related conditions and radiographs. All fractures consolidated in an axial position (<5 malposition in all planes) with full use of the affected limb. An additional stabilization by plaster casts (6 weeks) was used for the patient with fibrous dysplasia and the patient with long oblique fracture. Partial weight bearing was permitted after the removal of the cast or after 6 weeks for the other patients. Intramedullary nails have found their place in he management of femoral shaft fractures in children and even more so in adolescents. ESIN should be used as the procedure of choice for treating femoral fractures in children for many reasons including the economic reason.