Marcus Maier1, Ingo Marzi. 1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. Marcus.Maier@kgu.de
Abstract
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.
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.