Complications and failures of the ESIN technique.

Only knowledge of the possible failures and complications of a method allows its correct application. This also applies to ESIN (Elastic Stable Intramedullary Nailing), which has been promoted as a simple procedure. Most failures occur through neglect of the important biomechanical principles, and by obvious technical errors. The combination of both causes of failure can lead to serious complications in this method, which is generally regarded as "benign". These complications include serious rotational deformity, leg shortening, and growth disorders from growth plate injuries. A fundamental distinction must be made between intraoperative and postoperative problems and true complications. The present paper is intended to contribute towards avoiding such errors and detecting errors as early as possible during surgery in order to correct them.