Elastic stable intramedullary nailing for pediatric forearm fractures: A review article

Fractures of the shaft of the radius and ulna are common injuries in children and adolescents. Undisplaced fractures and fractures that are stable after closed reduction, can be treated with cast immobilization and an interosseous mold. Healing is reliable in children and remodeling would help to correct any residual malunion at the fracture site. However, in older children and adolescents, where the healing and remodeling potential is limited, and for unstable fractures, surgical intervention may be necessary. Intramedullary nailing using elastic nails, also known as elastic stable intramedullary nailing (ESIN) is the gold standard for surgical treatment of forearm fractures in children and adolescents, as it is physeal-sparing, safe, reliable and minimally invasive. There are several pearls and pitfalls related to the surgical technique of ESIN which would be discussed in this article. It does require a second surgery for removal of the nails once fracture is healed. The overall outcomes of ESIN of forearm shaft fracture are very satisfactory. Most of the complications are technique-related and can be avoided by meticulous attention to details. The aim of this narrative review article is to provide an overview of the indications, surgical techniques, clinical outcomes and potential complications of ESIN of forearm shaft fractures. It is important for orthopaedic surgeons who treat these fractures in children to master the art of ESIN.