Elastic Stable Intramedullary Nailing (ESIN) Provides Good Long-Term Results in Pediatric Long-Bone Fractures

The present study evaluates the long-term outcome of elastic stable intramedullary nailing (ESIN) in children with long-bone shaft fractures. 70 patients were examined, the present mean age of patients was 12.7 (+/- 3.26) years, mean time interval since surgery was 3.1 (+/- 1.49) years. Following ESIN at the lower extremity (23 femur fractures, 14 tibia fractures), keloid formation was remarkable in one patient, range of motion (ROM) was adequate in all but one boy (extension deficit of the hip of 10 degrees). Overall leg length discrepancy was +4.1 mm (+/- 5.2 mm) following ESIN for femur fracture and +3.2 mm (+/- 6.4 mm) following tibia fracture. Radiologically, all fractures had healed and no signs of avascular necrosis (AVN) could be detected. Malalignment was documented in one girl following tibia fracture (valgus of 12 degrees). Assessment of the upper extremity (28 forearm fractures, 5 humerus fractures) revealed keloid formation in 5 children. Impaired ROM was found in three children following ESIN for a forearm fracture (limited pro-/supination). Radiological controls detected one case of retrocurvation of the humerus (12 degrees, polytrauma patient) and one varus deviation of the radius in a 10-year old boy. Questioning the children about their opinion of the treatment, 93% considered the cosmetic results as good (6% fair), they judged the functional ability as perfect in 91% (9% fair) and 93% expressed great overall content (6% fair, 1% poor). In conclusion, ESIN provides good long-term results and can be a beneficial method for children with long-bone fractures.