Related Experiment Video
Updated: Jun 26, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
[Elastic stable intramedullary nailing of femur fractures in children]
1Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. Marcus.Maier@kgu.de
Insights
Elastic stable intramedullary nailing (ESIN) offers effective fracture stabilization in children. This minimally invasive technique yields good clinical results, particularly for transverse and oblique femur fractures.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Biomaterials Science
Background:
- Elastic stable intramedullary nailing (ESIN) is a minimally invasive osteosynthesis technique.
- It provides sufficient stabilization for pediatric fractures.
Purpose of the Study:
- To evaluate the efficacy and indications of ESIN for femur fractures in children.
- To outline the surgical technique, contraindications, and postoperative management.
Main Methods:
- ESIN is recommended for diapyseal femur fractures in children aged 4 years and older.
- Contraindications include open fractures with significant soft tissue injury and burst fractures.
- The technique involves inserting two flexible nails retrogradely via small incisions.
Main Results:
- ESIN is a well-accepted treatment for pediatric femur fractures, yielding good to excellent clinical outcomes.
- It is the preferred method for transverse and oblique fractures.
- Complex fractures (e.g., multi-fragment or metaphyseal) may be challenging and might require alternative treatments like external fixation.
Conclusions:
- ESIN is a successful, minimally invasive option for specific pediatric femur fractures.
- Careful patient selection is crucial for optimal outcomes.
- Alternative fixation methods should be considered for complex fracture patterns.
Objective:
Elastic stable intramedullary nailing (ESIN) is a minimally invasive osteosynthesis technique that allows sufficient stabilization of fractures in children.
Indications:
The stabilization of femur fractures with ESIN is recommended for diapyseal femur fractures in children > or = 4 years until closure of the growth plates.
Contraindications:
Open fractures with significant injuries to the soft tissues as well as burst fractures should not be treated with ESIN.
Surgical Technique:
Small incisions are made medial and lateral of the femur just above the distal growth plate. The cortex is perforated with an awl. The first ESIN is pushed via this perforation intramedullary retrograde via the fracture site to the proximal femur near the trochanteric region. Afterwards, the second nail is passed through the opposite cortex of the distal femur after opening it in the same way. The second nail has to be pushed parallel retrograde via the fracture site into the contralateral trochanteric region. The flexible nail design enables the surgeon to fix the fracture via a three-point stabilization.
Postoperative Management:
Postoperative mobilization is allowed on crutches with reduced weight depending on the type of fracture. According to the ESIN position transverse fractures allow an early switch toward full weight bearing, whereas in fractures with multiple fragments, weight bearing should be reduced for several weeks until radiologic healing is seen.
Results:
The minimally invasive method of ESIN is a well-accepted treatment option for femur fracture in children yielding good and excellent clinical results. It is the treatment of first choice for transverse and oblique femoral fractures (32-D/4.1 und 32-D/5.1). Fractures with several fragments (32-D/5.2) as well as fractures of the metaphyseal region (31-M/3.1 und 33-M/3.1) may be difficult to stabilize with ESIN and might alternatively be treated with an external fixator.
More Related Videos
07:41An Intramedullary Locking Nail for Standardized Fixation of Femur Osteotomies to Analyze Normal and Defective Bone Healing in Mice
Published on: November 13, 2016
07:35Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
