ESIN in Forearm Fractures

Abstract Background and Purpose: Elastic stable intramedullary nailing (ESIN) is well established for stabilizing pediatric forearm fractures. To prevent uncritical use, it is necessary to evaluate the problems and complications of this common technique. Patients and Methods: Four pediatric surgical departments participated in a retrospective study analyzing the last 400 fractures treated with ESIN. Continuous documentation of treatment, postoperative course and follow-up formed the basis of evaluation. In this article forearm fractures (n = 163, 40.7%) are discussed, and epidemiology, indication, fracture types, intraoperative technique, postoperative management and problems, as well as complications and results are compared to those described in the literature. Results: Complete, transverse fractures of the midshaft (73%) were mainly seen. Indication for intervention was an intolerable axial deviation (85.9%). Intraoperative technique (operating and transillumination time, site of approach, material choice) and postoperative management (hospital stay, number of X-ray controls, and follow-up) differed highly depending on the hospitals circumstances. Postoperatively, 3.0% of patients showed soft-tissue irritation due to sharp nail ends or wound infections. Complications (10.4%) included secondary rupture of a tendon in 3.7%, refracture with nails in situ in 2.5%, axial deviations > 10° or instability of osteosynthesis in 1.8%, delayed healing in 1.2%, migration of nails in 0.6%, and technical failure in 0.6%. Overall, a significant functional restriction (limitation of movement > 10°) was found in three cases only (1.8%) following radial neck fracture. Conclusion: ESIN in pediatric forearm fractures is an often used technique with clear indications and excellent results to be expected. Numerically, complications have not altered considerably, but they rather show a shifting of problems with optimization and refinement of technique and improvement of equipment. Thus, continuous evaluation of technical principles and procedural recommendations constitutes the mainstay in the prevention of problems and complications.