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[Use of the elastic stable intramedullary nailing technique in non-typical pediatric fractures]
1Centrum dĕtské traumatologie, odd. dĕtské chirurgie, Fakultní Thomayerova nemocnice, Praha. petr.havranek@fth.cz
Insights
Elastic Stable Intramedullary Nailing (ESIN) is effective for various pediatric fractures. This technique shows promising results in diaphyseal, metaphyseal, and digital bone injuries in children, simplifying treatment and yielding good outcomes.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Traumatology
Background:
- Elastic Stable Intramedullary Nailing (ESIN) is a recognized treatment for pediatric diaphyseal long bone fractures.
- The technique's application has been explored for broader indications in the growing skeleton.
Purpose of the Study:
- To evaluate the efficacy of ESIN in treating diaphyseal long bone fractures.
- To assess the adaptability of ESIN for metaphyseal long bone fractures and injuries of metacarpals, metatarsals, and phalangeal bones in children.
Main Methods:
- A retrospective study of 97 children treated with ESIN between 1999-2000.
- Patients were categorized into three groups: Classic ESIN (diaphyseal fractures), Non-typical ESIN (metaphyseal fractures), and ESIN-like (digital fractures).
- The core technique involved supraphyseal trepanation and intramedullary insertion of prebent elastic nails.
Main Results:
- All 97 children achieved good healing.
- Minor complications occurred in four patients, including one requiring external fixation, one with delayed union, one with tibial overgrowth, and one with radial head subluxation.
- The procedure demonstrated simplicity, short operation time, and positive outcomes in metaphyseal and digital fracture groups.
Conclusions:
- ESIN is a viable treatment option for three distinct pediatric fracture categories: diaphyseal, metaphyseal, and digital.
- The 'Non-typical ESIN' and 'ESIN-like' procedures offer effective solutions for metaphyseal and digital fractures, respectively.
- The study established three main indication groups for the ESIN technique in pediatric trauma.
Purpose Of The Study:
The "Elastic Stable Intramedullary Nailing" (E.S.I.N.) of French authors as a method of treatment of children's diaphyseal long bone fractures is well known from nineties of the last century. After we got familiar with the technique we wanted to introduce it in other indications, especially some metaphyseal long bone fractures and injuries of metacarpals, meta-tarsals and phalangeal bones in the growing skeleton.
Material:
During two last years, i.e. 1999-2000, ESIN procedure in 97 children was performed in our Regional Pediatric Trauma Centre. That was 39% of all osteosyntheses and 3.05% of all children's fractures treated during this period. Children treated by ESIN procedure were divided into three groups (see in Methods), 52 being in group one, 28 in group two and 17 in group three.
Methods:
In our series of patients managed with the use of ESIN procedure according to the type of fractured bone and physical behavior of the implants three groups were formed. In the first group called "Classic ESIN Procedure" were children with diaphyseal long bone fracture (femur, tibia, humerus and forearm bones), in the second group "Non-typical ESIN Procedure" metaphyseal long bone fractures (humerus, radius, tibia) and in the third group, "ESIN-like Procedure" patients with metacarpal and phalangeal digital fractures were included. In all children the technique was very similar to original French (Nancy) description. Supraphyseal trepanation of the bone and introduction of usually two prebent elastic nails intramedullary.
Results:
All 97 children healed good. In four children we saw little problems. In one patient it was necessary to change the ESIN osteosynthesis of open tibia fracture to external fixation. In the other boy we saw delayed union of forearm bones and in the third a 2 centimeter overgrowth of the affected tibia was recorded. In the last boy where non-typical ESIN procedure was performed for proximal radial fracture separation the angulation of radial head, overgrowth and subluxation occurred. However, we were surprised by simplicity, short time of the procedure and good results in two new groups of patients with metaphyseal and metacarpal resp. phalangeal fractures.
Discussion:
Though in metaphyseal long-bone fractures (Non-typical ESIN Procedure) and metacarpal and phalangeal digital fractures (ESIN-like Procedure) the technique does not respect original physical suggestions of three point fragment fixation it works very well. Already the French authors from Nancy mention the indication of the ESIN technique for some metaphyseal fractures (supracondylar humeral and proximal radial). We do not use the method in supracondylar fractures but found it excellent in earlier problematic proximal humeral and radial fractures and especially phalangeal digital fractures. Also we were able to establish three main indication groups for this procedure.
Conclusions:
The ESIN technique can be used in three groups of children's fractures. "Classic ESIN Procedure" in diaphyseal long bone fractures, "Non-typical ESIN Procedure" in metaphyseal long bone fractures and "ESIN-like Procedure" in metacarpal and phalangeal digital fractures.