Elastic Stable Intramedullary Nailing (ESIN) in Diaphyseal Fractures of Both Forearm Bones in Children

Background Diaphyseal fractures of both forearm bones are common in children. Although most cases can be managed conservatively, surgical treatment is indicated for unstable, irreducible, open, or complicated fractures. Elastic stable intramedullary nailing (ESIN) has emerged as a minimally invasive option with favorable functional and radiological outcomes. Methods We conducted a retrospective descriptive study including 38 children younger than 15 years with diaphyseal fractures of both forearm bones treated with ESIN in the Department of Pediatric Surgery at Moulay Ali Cherif Regional Hospital, Errachidia, Morocco, between January 2019 and December 2024. Epidemiological, clinical, radiological, therapeutic, and outcome data were collected from medical records and follow-up consultations. Functional outcomes were assessed according to pain, mobility, pronation-supination, and return to daily activities. Anatomical and radiological outcomes were also evaluated. Results The series showed a marked male predominance, with 35 boys (92.1%) and 3 girls (7.9%), with a mean age of 13 years. Direct trauma was the main mechanism of injury (n=27, 71.1%), and falls were the leading cause (n=32, 85%). The left side was affected in 24 cases (63.2%). Open fractures were recorded in 10 cases (26.3%), including six stage I (15.8%) and four stage II (10.5%) according to the Cauchoix and Duparc classification. The middle third of the forearm was the most frequent fracture site (n=24, 63.2%), and transverse fractures of both bones were the predominant pattern (n=24, 63.2%). The main indications for ESIN were irreducibility (n=29, 76.3%), instability after orthopedic reduction (n=7, 18.4%), and compartment syndrome (n=2, 5.3%). Open reduction was necessary in five cases (13.2%). Clinically, all patients achieved painless limbs with full strength and return to activities, except for two patients (5.3%) with compartment syndrome who developed persistent neuromuscular sequelae. Radiological outcomes were satisfactory. The main complication was skin irritation related to nail prominence in seven cases (18.4%), without the need for hardware removal. Conclusion ESIN is a reliable, minimally invasive, and effective technique for the treatment of pediatric diaphyseal fractures of both forearm bones. It provides high union rates, satisfactory functional recovery, and a low complication profile. ESIN represents a valuable surgical option, particularly for unstable or irreducible fractures.