Utility of Elastic Stable Intramedullary Nails in Pediatric Forearm Fracture Fixation: Overview of Technique and...

Paediatric forearm fractures are the second most common after clavicle fractures. The radius and ulna function as a rotational unit due to their articulations and are biomechanically akin to intra-articular fractures. Surgical fixation is often required to mitigate pronation-supination restriction. ESIN is widely used for diaphyseal forearm fractures and has seen expanded indications, including Distal Radius Meta-Diaphyseal Fracture (DRMDF), Monteggia Fracture Dislocation (MFD), and Radial Neck Fracture (RNF), with varied approaches and techniques.

This narrative review aims to discuss in detail the key pearls and potential pitfalls of ESIN in paediatric diaphyseal forearm fractures and its extended application in other forearm fractures.

A comprehensive review was conducted in the electronic databases (PubMed, Cochrane, and Scopus) with keywords from 2015 to 2024. The PRISMA chart was created after establishing the inclusion and exclusion criteria. A total of 72 articles were deemed suitable for inclusion.

There is a wealth of literature regarding treating pediatric diaphyseal fractures and RNF using ESIN. In contrast, limited literature is available on treating pediatric MFDs and DRMDFs with ESIN. This minimally invasive method offers good stability at the fracture site, with very few comparative studies with ESIN for DRMDF and MFD exits.

ESIN has emerged as a transformative approach in managing pediatric forearm fractures. Its adaptability to complex fracture patterns, coupled with technique modifications and extended indications, underscores its clinical utility. By facilitating early mobilization and preserving fracture biology, ESIN supports enhanced functional recovery and expedites return to regular activity.

The online version contains supplementary material available at 10.1007/s43465-025-01633-w.