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Objective: To investigate the application of modified elastic intramedullary nail and the outcomes between modified elastic stable intramedullary nailing and traditional elastic stable intramedullary nailing in children with distal tibial metaphyseal junction fracture. Methods: A retrospective study was conducted. From January 2018 to January 2021, a total of 36 children with distal tibial metaphyseal junction fracture were treated in our hospital. All of them were treated with closed reduction and elastic stable intramedullary nailing internal fixation. A total of 18 children were treated by modified elastic stable intramedullary nailing and 18 children were treated by traditional elastic stable intramedullary nailing. Postoperative imaging, clinical efficacy, and complications were analyzed. Results: The mean follow-up time was 20 (15–36) months in modified group and 22 (16–33) months in traditional group. There were no complications such as infection, loss of reduction, and unequal length of lower limbs in modified group while loss of reduction occurred in two cases in traditional group. In these two cases of loss of reduction, we preformed manual reduction and replacement of long leg casts, and there was no loss of reduction, and the patient achieved a good prognosis. In the last follow-up, American Orthopaedic Foot & Ankle Society score was used. In modified group, excellent outcome achieved in 17 cases, good outcome achieved in 1 case, and satisfactory therapeutic effect was achieved. In traditional elastic stable intramedullary nailing group, excellent outcome achieved in 14 cases, and good outcome achieved in 4 cases. There was no statistical difference in the scores between the two groups. Conclusion: It was concluded that modified elastic stable intramedullary nailing fixation is a safe and effective treatment. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to compare the different internal fixations between elastic stable intramedullary nailing and Kirschner wires in treatment of angulated radial neck fractures. Methods: We retrospectively reviewed the patients with radial neck fracture without associated injuries who underwent surgery approach in our department during April 2011–March 2020. There were 62 patients meeting all the criteria with complete clinical data, with median age of 7.5 (IQR 5.8–9.5) years, 34 males and 28 females. The preoperative fracture pattern was assessed according to the Judet classification system. Depending on the materials implanted and fixation strategy, the patients could be divided into a Kirschner wire group and an elastic stable intramedullary nailing group. Final functional outcomes of patients were assessed by the Mayo Elbow Performance Score and Tibone–Stoltz functional evaluation classification. Results: The Kirschner wire group included 37 patients, with 4.8 years median follow-up. The elastic stable intramedullary nailing group included 25 patients with 5.9 years median follow-up. There were no significant differences in gender, age, Judet classification, average operative time, Mayo Elbow Performance Score, Tibone–Stoltz classification, or length of hospital stay between groups. However, the time to union in the Kirschner wire group was significantly shorter than that in the elastic stable intramedullary nailing group (p < 0.05). Both groups achieved satisfactory functional and cosmetic results. Conclusion: In the management of pediatric radial neck fractures, both elastic stable intramedullary nailing and Kirschner wire internal fixation have shown equivalent therapeutic results, leading to satisfactory functional outcomes. The selection of the internal fixation approach can be influenced by the patient's fracture characteristics and the surgeon's preferences. Level of evidence: Level III; Retrospective Comparison; Treatment Study. [ABSTRACT FROM AUTHOR]

Background: Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods. Materials and Methods: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications. Results: We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = − 28.93, 95% CI (− 52.88 to − 4.98), P < 0.05], less blood loss [MD = − 66.94, 95% CI (− 87.79 to − 46.10), P < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22–4.07), P < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, P = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, P = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, P < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, P = 0.11). Conclusions: ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of irreducible distal radius diaphyseal- metaphyseal junction fractures involves difficulties as the fracture remains too proximal for K-wire fixation and too distal for the elastic stable intramedullary nail. Our study aims to present the clinical results of applying an elastic stable intramedullary nail with a poller K-wire to achieve both reduction and stable fixation. Patients and methods: A retrospective analysis was performed on 26 patients who underwent ESIN with a poller K-wire for distal radius diaphyseal-metaphyseal region fracture. Reduction parameters such as residual angulation and alignment were evaluated on postoperative follow-up radiographs. Changes in angular and alignment parameters on follow-up radiographs were recorded. Wrist and forearm functions were evaluated at the last follow-up. Result: There were 17 male and nine female patients with an average age of 10.9. The residual angulation in coronal and sagittal planes on immediate postoperative radiographs was 4.0 ± 1.62° and 3.0 ± 1.26°, respectively. The mean translation rate on immediate postoperative radiographs was 6.0 ± 1.98% and 5.0 ± 2.02% in the coronal and sagittal planes, respectively. No change was observed in translation rates in the last follow-ups. The mean angulation in the coronal and sagittal planes measured on 6th-week radiographs was 4.0 ± 1.72°and 3.0 ± 1.16°, respectively. No significant difference was observed in angular changes in the sagittal and coronal planes at the last follow-up (p > 0.05). No tendon injury or neurovascular injury was observed in any of the patients. Conclusion: In the surgical treatment of pediatric DRDMJ fractures, applying ESIN with poller K-wire is an effective, safe, and novel method for achieving reduction and stable fixation. [ABSTRACT FROM AUTHOR]

Purpose: The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is "3-point support and fixation," and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail. This study aims to present a novel tool for pre-bending the elastic stable intramedullary nails and the results of using this tool by surgeons. Methods: A designed case of femoral shaft fracture was provided to the participants. All participants were divided into three groups according to their experience with the elastic stable intramedullary nail technique: resident, fellow, and attending groups. The time of completing the pre-bending and coronal plane deviation of the nails after pre-bending was recorded. Statistical analysis compared the data in a conventional way and with the new tools in each group. Results: A total of 30 physicians were recruited in this study. The pre-bending duration with the new tool was significantly shorter than that of the conventional method for all physicians (p < 0.001). The coronal plane deviation of nails after pre-bending by the new tool was significantly smaller than that of the conventional method for all physicians (p < 0.001). Conclusion: This novel tool for elastic stable intramedullary nail pre-bending was convenient and easy to use in achieving the principal role of the elastic stable intramedullary nail technique. Physicians could reduce the coronal plane deviation when pre-bending elastic stable intramedullary nails, especially for physicians with less experience with the elastic stable intramedullary nail technique. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: Elastic stable intramedullary nailing (ESIN), developed by the Nancy school in France, is the gold standard for surgical treatment of long bone fractures in children. In Africa, few works have been devoted specifically to this technique. Objective: This study aimed to describe the outcome and to present the challenges with this technique in the treatment of long bone fractures in children. Patients and Methods: This was a prospective and descriptive study over 4 years including patients aged 0-15 years old operated using ESIN. Results: Sixty-two patients underwent ESIN, of whom 44 patients (70.96%) were for femur fractures, nine patients (14.52%) for tibia and fibula fractures and nine patients (14.52%) for humerus fractures. The majority of the patients treated with ESIN were children older than 6 years. Nine patients (14.51%) and 13 patients (20.98%) underwent ESIN following polytrauma and multiple fractures, respectively. Seven patients (11.29%) were operated on through-closed ESIN method. The unavailability of image intensifier (38.71%) and the presence of bone callus (40.32%) were the major reasons for using the open ESIN method. Thirty-three patients (53.23%) had minor or major complications. The majority of patients had satisfactory therapeutic outcomes. Conclusion: ESIN gives good results, even when the fracture site is approached. [ABSTRACT FROM AUTHOR]

Objective To explore the causes and outcomes of delayed fracture union after elastic stable intramedullary nailing (ESIN) for pediatric long bone fractures of extremities to minimize the occurrence of this complication and provide clinical rationales for managing delayed fracture union. Methods From July 2015 to April 2020, clinical data were retrospectively reviewed for 233 children with long bone fractures of extremities after ESIN.Nine cases of delayed fracture union were found during follow-ups.Age, injury mechanism, fracture site, surgical approach, post-discharge management and subsequent rehabilitation were recorded.For various causes of delayed fracture union, the corresponding treatment was offered. Results Two cases of delayed fracture union of double fracture of radius and ulna healed after prolonged plaster fixation and immobilization.Two cases of delayed tibial fracture union received proper weight bearing under brace protection.One case of delayed fracture union of femoral fracture healed after external fixation of hip with heriform plaster and removal of elastic intramedullary nail.One case of delayed fracture union of tibia (n=1), humerus (n=1) and femur (n=1) healed after anti-infection and immobilization of affected limb.One case of delayed tibial union underwent autologous bone grafting and plaster fixation. Conclusion Treatments of delayed bone union vary for different and different types of fractures.In this cohort, strengthened fixation, greater stress stimulation at broken end, anti-infection, bone graft reconstruction and other means have been adopted for attaining bone union.Removing the influencing factors of delayed healing and re-stabilizing fracture end are vital for successful treatments. [ABSTRACT FROM AUTHOR]

Background: In children, femoral shaft fractures are often treated using elastic stable intramedullary nailing (ESIN). Objective: To evaluate the functional as well as clinical outcomes of ESIN for femoral fractures in children aged 4-11 years. Patients and Methods: At Orthopedic Surgery Department of Zagazig General Hospital 18 cases diagnosed as pediatric femoral fractures were stabilized using flexible intramedullary nailing. Results: Skin irritation due to nail endings was the most prevalent consequence and was seen in 7 patients. Other complications were superficial infection (n=2), limb length inequility (n=2) and varus angulation (n=1). At 3 months follow-up, all patients had complete range of motion in their hips and knees; three patients (27.77%) had slight restriction in knee flexion, but this was recovered by 6 months follow-up. Excellent Flynn elastic nail scoring results were demonstrated in 72.22%, satisfactory results in 27.77% and none of the patients showed poor results. Conclusion: Flexible Intramedullary Nailing resulted in the best possible functional and radiological outcomes for patients with femoral shaft fractures and is a safe treatment option. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric radial neck and head fractures are rare, accounting for only 1% of all fractures in children. The aim of this study is to describe the management and results of the respective fracture types and different injury characteristics. Materials and methods: This study performs a retrospective data analysis of 100 consecutive patients with a fracture of the proximal radius treated in a single high-volume pediatric trauma center. Results: One hundred patients [mean age 7.5 years (1–15)] were documented with a fracture of the proximal radius between 3/2011 and 12/2019. The gender distribution was 62 girls and 38 boys. Twenty-seven patients had concomitant injuries. Conservative treatment was performed in 63 patients (Judet I = 27; II = 30; III = 6; Mason I = 2) using an above-the-elbow cast for 21 days (6–35). Surgical treatment was performed in 37 patients (Judet II = 3; III = 22; IV = 5; V = 7) using elastic stable intramedullary nailing (ESIN). Open reduction was necessary in five cases, and additional immobilization was performed in 32 cases. Six complications occurred: loss of implant stability (n = 2), healing in malalignment, pseudarthrosis, radioulnar synostosis, and a persisting hypoesthesia at the thumb. As a result, two ESIN osteosynthesis were revised, and one radial head resection was performed. Loss of movement was seen in 11% of cases, overall Mayo elbow performance index (MEPI) was 99.8 (90–100), and none of the patients experienced negative impacts on activities of daily life. Conclusions: Proximal radial fractures occur predominately without dislocation. Good results are obtained with conservative treatment throughout. In cases with displacement exceeding growth-related correction, ESIN is the undisputed treatment of choice. Open surgery and long immobilization periods should be avoided whenever possible. [ABSTRACT FROM AUTHOR]

Background: Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device.Materials and Methods: A retrospective analysis was performed on 44 children (age 6-11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery.Results: No differences were observed comparing Group A and B in terms of the maintenance of reduction (P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM (P < 0.05). No differences were revealed in terms of complications between the two groups.Conclusion: ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Forearm fractures are the third most prevalent in children, accounting for 40% of all fractures in children. Using titanium elastic nailing techniques to fix both fractures of the forearm revealed a lot of benefits. Objective: This study aimed to determine if elastic nail fracture treatment improves the radiological and clinical outcomes in children. Patients and methods: 18 patients with fracture shafts of both bones forearm treated with intramedullary elastic nails were studied in Zagazig University Hospital and Sebha medical centre, Sebha, Libya for this prospective clinical trial. Patients returned for follow up visits nearly every 2 weeks following fixation for removal of suture. Then Serial radiographs were made after 2 weeks, 4 weeks, 6 weeks and 12 weeks after surgery. They were evaluated for callus formation and assessment of range of motion and any complications till complete bone healing. Results: Between 8 and 14 weeks, the average time for union was 10.38 ±1.72 weeks. According to the Price score majority were excellent 77.8%, then good 16.7% and finally fair 5.6%, Only 2 cases 11.1% had complication (Surgical site infection, superficial radial nerve injury, and re-displacement). Complicated cases were significantly associated with road traffic accident and Fair price score. Excellent cases were significantly associated with younger age and shorter union time. Conclusion: For the treatment of displaced forearm fractures, Elastic Stable Intramedullary Nailing (ESIN) is a safe and effective option for young patients. Effective and definitive therapy of these fractures is still achievable with this less invasive approach. A functional outcome was attained without the need for corrective treatments, angulations, or repeated reductions. [ABSTRACT FROM AUTHOR]

Background: Spica casting and elastic stable intramedullary nailing (ESIN) are options for diaphyseal femur fractures in preschool-age children (ages 3-6 years). Clinical practice guidelines (CPG) are only of moderate or limited strength, which may lead to variation in practice. The purpose of this study is to analyze the epidemiology of children undergoing these procedures in the United States.Methods: The Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for patients between the ages of 3 and 6 years undergoing spica casting or ESIN for a diaphyseal femur fracture between 2011 and 2017. Non-diaphyseal fractures, subjects with associated syndromes or neuromuscular disorders, and pathologic fractures were excluded. Census guidelines were used to categorize hospitals geographically into regions and divisions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders.Results: Analysis included 4059 subjects. Spica casting was performed in 2878 children (71%) and ESIN in 1181 (29%). The median age of those undergoing spica casting was 3.0 years [interquartile range (IQR) 1 year] compared to 5.0 years for ESIN (IQR 2 years; p<0.01). When adjusting for covariates in a multivariate model, each year of increasing age resulted in 4.4 times higher odds that ESIN would be performed (95% CI 4.0-4.8, p<0.01). Compared to the Northeast, a child in the Midwest had 3.6 times higher odds of undergoing ESIN rather than spica casting (95% CI 2.6-5.1, p<0.01). Age at time of ESIN was lowest in the Midwest and highest in the Northeast (4.8±1.0 versus 5.3±0.9 years; p<0.01). There was no variation in the ratio of spica casting to ESIN performed in this age group between 2011 and 2017, including after release of the 2015 CPG.Conclusions: In the United States, there is substantial variation in the chosen treatment for diaphyseal femur fractures in preschool-age children. ESIN is more likely to be chosen for older children. It is also most likely to be performed in the Midwest and least likely in the Northeast. These findings may have implications in terms of cost and resource utilization and suggest the need for more clinical data to guide surgical indications. [ABSTRACT FROM AUTHOR]

Purpose: The health-related quality of life (HRQoL) after conservatively versus surgically treated paediatric proximal humeral fractures is poorly understood. We assessed the HRQoL after this injury and asked if HRQoL was associated with age, radiological classification or treatment chosen. Methods: We identified 228 patients who were treated for proximal humeral fractures between 2004 and 2017. These patients completed the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) (primary outcome), the Paediatric Quality of Life Inventory (PedsQL) and questions regarding patient satisfaction. Fractures were classified radiologically following the Paediatric Comprehensive AO Classification. Results: We were able to follow-up on 190 children; 147 (mean age 8.7 years (0.8 to 15.7)) sustained a metaphyseal and 43 (mean age 11.6 years (3.7 to 15.8)) sustained a Salter Harris type I or II injury. Most fractures (90%) were simple, 10% were multifragmentary. In total, 137 children (72%) were treated nonoperatively, 51 (27%) were treated by elastic stable intramedullary nailing (ESIN). After a median follow-up of 7.6 years (0.8 to 14.3) there was an overall mean Quick-DASH of 4.3 (SD 9.3) for girls and 1.2 (SD 3.1) for boys. The mean function score of the PedsQL was 94.7 (SD 11.1) for girls and 98.0 (SD 6.0) for boys. The mean psychosocial score of the PedsQL was 92.0 (SD 11.1) for girls and 94.1 (SD 11.6) for boys. Most children (79%) were very satisfied with the cosmetic result and 74% were very satisfied with the treatment overall. Surgery and female sex were associated with lower satisfaction. Conclusion: In this cohort of 190 patients, where immobilization for mildly displaced fractures, and closed reduction and ESIN was used for displaced fractures, there was equally excellent mid- and long-term HRQoL when assessed by the Quick-Dash and the PedsQL. [ABSTRACT FROM AUTHOR]

Background: Congenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods. Methods: A multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent—plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients' satisfaction and function following treatment at each follow-up. Results: There were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups. Conclusion: Surgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients. Level of evidence: Retrospective comparative study; Level III [ABSTRACT FROM AUTHOR]

Purpose Radiation-induced cancers due to imaging devices concern above all the growing child, however, to date, intraoperative irradiation doses are not well-documented in children. The goal of the study was to evaluate the intraoperative doses received by patients operated with the use of a C-arm in traumatology, as well as the lifetime attributable risk of cancer death (LAR) related to the irradiation of the imaging device. Methods From 1 April 2017 to 31 March 2019, we started a multicentre study and prospectively recruited all consecutive children who needed elastic stable intramedullary nailing (ESIN) for long-bone fracture. We collected demographic and operative data, with dose reports including duration and doses. The main outcome was the effective dose (ED) in millisievert (mSv), calculated with PCXMC software, and the secondary outcome was the LAR expressed as a percentage. Results In all, 51 patients operated on using 2D C-arm imaging were included in this study. The mean ED was 0.085 mSv (sd 0.10; 0.002 to 0.649). Overall LAR was 6.5 x 10-4% (sd 6.7 x 10-4%; 0.1 x 10-4% to 28.3x10-4%). Univariate linear regression showed a significant association between ED and irradiation time (p < 0.001). There was no significant association between ED and other outcomes (p > 0.05). Conclusion Treatment of long-bone fractures by ESIN found a low level of effective doses with utilization of the C-arm device in current practice. Further studies on a larger sample are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Introduction: The gold-standard surgical procedure of both-bone forearm shaft fracture repair is elastic stable intramedullary nailing (ESIN). Disadvantages effects of ESIN have suggested to be a consequence of inappropriate surgical techniques, while recommendations are not always followed. The purpose of the study was to analyze the effect of inadequate metal frame construct on impaired fracture healing, refracture and changing alignment.Materials and Methods: It is a population-based study including all consecutive patients, aged less than 16 years, who had been treated for forearm shaft fracture by ESIN during the ten-year period 2009-2018. Altogether 71 patients were included. Non-union, delayed union, and re-fracture during the following 12 months were taken as the main outcome, while inferior metal frame construct of ESIN and the surgical technique characteristics were taken the explanatory factors. Radiographic loss of reduction was a secondary outcome and a change >5° in alignment at any postoperative follow-up exam was recognized.Results: Two out of 71 fractures (3%) failed to unite, and ossifying operation was needed. Five cases (7%) showed delayed bone healing, but they ossified in five months without any intervention. These seven patients (10%) had been treated more often with larger nails (> 0.7x MCD) (p = 0.027) and by open reduction (p = 0.02), compared with thinner nails and closed reduction, respectively. Two (3%) patients had a second fracture; however, they happened 2 years after the initial injury. Other surgery or fracture related factors didn't associate with impaired ossifying. Regarding the secondary outcome, altogether 24 (35%) of the analyzed 67 patients showed >5° change in alignment during the postoperative follow-up but only one patient had clinically significant instability that required re-reduction. The alignment changed more usually in distal-third fractures, compared with middle or proximal third fractures (p = 0.019).Conclusions: ESIN resulted in good radiographic bone healing in the vast majority (90%) of the patients and completely perfect metal frame construct was not required. [ABSTRACT FROM AUTHOR]

Six apparently healthy dogs of either sex with fracture of long bone were selected for the study. All the six dogs were treated by elastic stable intramedullary nailing technique under general anaesthesia. Haematological and biochemical evaluations were conducted preoperatively, on the day of surgery, postoperatively on second, fourth, sixth and eighth week. The variations from the normal physiological range could be seen in the level of granulocytes, haemoglobin, volume of packed cells and total erythrocytes count, but remaining haematological parameters were within the normal level during the observation period. Statistically significant variations could be seen in the findings of lymphocytes and granulocytes. A mild elevation in the serum phosphorus level could be noticed on the day of surgery and remaining biochemical parameters were within the normal physiological level throughout the observation period. Serum calcium level was significantly higher on the eighth postoperative week compared with that of the day of surgery. Statistically significant elevation in the level of alkaline phosphatase was noticed on preoperative day, day of surgery and second postoperative week when compared with that of eighth postoperative week. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing (ESIN).Methods: Clinical data of 267 patients who had been treated for forearm fractures by ESIN in our hospital from January 2010 to December 2014 were retrospectively reviewed. Risk factors for forearm refractures were determined using logistic regression analysis.Results: Forearm refractures occurred in 11 children. Univariate analysis revealed that age, body weight, number of fractures, open fracture, nail diameter, and immobilization time were not associated with refractures. However, gender (male, P = 0.042) and fracture location (lower third, P = 0.007) were significantly associated with refractures. Multivariate analysis revealed that fracture location was an independent risk factor for forearm refractures (P = 0.031).Conclusion: Forearm refracture is uncommon in children treated with ESIN. Fracture location is an independent risk factor for forearm refractures in these patients. [ABSTRACT FROM AUTHOR]

Background: Surgical stabilization of displaced midshaft clavicle fracture can be achieved by an intramedullary nail or plate. When intramedullary nail is used, one of the dreaded complications is the migration of nail. We have used a screw intramedullary device with screw mechanism at one end which can get hold in the medial cancellous bone, thus preventing chances of nail migration. The aim of our study was to evaluate the clinical outcome following elastic stable screw intramedullary nailing for the fixation of midshaft clavicle fractures. Materials and Methods: 36 patients of midshaft clavicular fractures, who met inclusion criteria, were included in this retrospective study. There were 28 males and 8 females. The mean age was 36.6 years. Twenty one patients were managed by close reduction and fixation with screw intramedullary nail. Fifteen patients required mini-open reduction. Followup examination was done at 1 month, 3 months, and 6 months using patient’s subjective evaluation, functional outcome, radiographic assessment, and other complications. Results: Union was achieved at average of 11.6 weeks in 31 cases and five patients went to delayed union. The average followup was 6 months. The average constant score was 90%. Three patients had medial nail protrusion which required early removal after union. Conclusion: Screw intramedullary nail is a safe, minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and good functional results, and can be used as an equally effective alternative to plate fixation in displaced midshaft clavicle fractures. [ABSTRACT FROM AUTHOR]

Background: Surgical stabilization of displaced midshaft clavicle fracture can be achieved by an intramedullary nail or plate. When intramedullary nail is used, one of the dreaded complications is the migration of nail. We have used a screw intramedullary device with screw mechanism at one end which can get hold in the medial cancellous bone, thus preventing chances of nail migration. The aim of our study was to evaluate the clinical outcome following elastic stable screw intramedullary nailing for the fixation of midshaft clavicle fractures. Materials and Methods: 36 patients of midshaft clavicular fractures, who met inclusion criteria, were included in this retrospective study. There were 28 males and 8 females. The mean age was 36.6 years. Twenty one patients were managed by close reduction and fixation with screw intramedullary nail. Fifteen patients required mini-open reduction. Followup examination was done at 1 month, 3 months, and 6 months using patient's subjective evaluation, functional outcome, radiographic assessment, and other complications. Results: Union was achieved at average of 11.6 weeks in 31 cases and five patients went to delayed union. The average followup was 6 months. The average constant score was 90%. Three patients had medial nail protrusion which required early removal after union. Conclusion: Screw intramedullary nail is a safe, minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and good functional results, and can be used as an equally effective alternative to plate fixation in displaced midshaft clavicle fractures. [ABSTRACT FROM AUTHOR]

Objective: To observe and compare the clinical efficacy of plate fixation (PF) with elastic stable intramedullary nailing (ESIN) iu the treatment of midshaft femoral fractures in children. Methods: 90 cases of pediatric midshaft femur fractures from February 2013 to December 2016 were selected and divided into two groups according to different treatment WITH45 cases in each group: elastic stable intramedullary nailing group (ESIN) and plate fixation group (PF) group. The indexes of operation time, surgical incision, intraoperative blood loss, postoperative wound drainage were compared between the two groups. The hospital stay, full weight bearing time, time of fracture healing: final functional outcomes were evaluated using Flynn's system. Results: There was no significant difference in the blood loss and postoperative drainage between the two groups (P>0.05). The surgical incision of ESIN group was significantly smaller than that of the PF group (P<0.05). The operation time and fluoroscopy time and tune of total load-bearing were significantly shorter in ESIN group (P<0.05). The therapeutic effect of ESIN group was superior to that of the PF group (P<0.05). Conclusions: Compared with the plate fixation, the operation time and the fluoroscopic tune were significantly shorter in the ESIN. The clinical curative effect of ESIN was also superior to the PF in the treatment of midshaft femoral fractures in children. The elastic intramedullary nail should be the fixation material for the femoral shaft fracture in children. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to assess treatment outcomes in children weighing 50 kg (110 pounds) or more with displaced femur shaft fractures treated by elastic stable intramedullary nailing (ESIN) and to identify potential correlations between nail size/medullary canal diameter ratio and outcome.Methods: Twenty out of 117 consecutive children surgically treated by ESIN for displaced fractures of the femoral shaft with no associated neurovascular injury weighed 50 kg (110 pounds) or more. All patients underwent regular clinical and radiographic follow-up for at least one year after their index surgery.Results: The average patient age at the time of injury was 13.1 years (25th and 75th interquartile range [IQR] = 11.7-14.5). The mean follow-up was 27.4 months (IQR = 18.4-36.8). Overall, nine (45 %) adverse events were observed. The rate of complications was higher among children weighting 55 kg and over (67 %) than in children weighing less than 55 kg (35 %) and among children aged 13 years old or older (72 %) than among children younger than 13 years old (11 %).Discussion: Femoral shaft fractures in children and adolescents weighing 50 kg (110 pounds) and over and older than ten years of age have an increased rate of complications.Conclusion: Heavier patients have a greater chance of complications. In particular, patients younger than 13 years old and weighing less than 55 kg can be safely managed with ESIN, but older and heavier patients should preferably be treated with rigid fixation systems due to a greater complication rate. However, further studies are needed to consolidate the conclusions. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to retrospectively investigate the clinical and radiological outcome of humeral shaft fractures treated by ESIN in children <16 years old and to evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH). Methods: We retrospectively evaluated children with fractures of the humeral shaft, surgically treated by ESIN. All the patients were regularly followed clinically and radiographically for at least 1 year after their index surgery. After hardware removal, the patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH). Results: Thirty-eight patients met the inclusion criteria. Mean age at the time of trauma was 11.1 years. Mean follow-up was 30 months. All fractures healed, but three patients had a residual valgus of >10°, two a residual varum of >10°, four a residual recurvatum deformity of >10°, and one a residual procurvatum deformity of >10°. Four complications were observed. Functional outcome was nevertheless good in all the patients, with a mean Quick DASH score of 3. Conclusion: The study shows good clinical and functional outcomes in children and adolescents with closed isolated fractures of the humeral shaft surgically treated by ESIN, even with ensuing mild residual frontal and sagittal plane deformity. However, conservative treatment has also been advocated in the scientific literature for this type of injuries, and surgical treatment should not be considered as the only option for the management of humeral shaft fractures in older children and adolescents. [ABSTRACT FROM AUTHOR]

Fracture geometry, frequency, the accident mechanism and soft tissue damage in isolated tibial shaft fractures and fractures of the lower leg of the growing skeleton are essentially age-dependent. For a long time the treatment of shaft fractures was the domain of conservative therapy. With the development of elastic stable intramedullary nailing (ESIN) a minimally invasive technique is now available, which can be employed as an alternative in many situations. For the lower leg strict age-dependent correction limitations must be taken into consideration for treatment. Isolated tibial shaft fractures have a high risk of a secondary varus malposition. Fractures of the lower leg have a tendency towards a valgus malposition. All fractures which are not dislocated can be conservatively treated with an above knee plaster cast. Unstable fractures should be repositioned with the patient under general anesthesia. If there is evidence of instability after repositioning with an increased risk of secondary dislocation, treatment with ESIN in the sense of a primary definitive treatment should be strived for in children over 9 years old. The extent of soft tissue damage has a decisive influence on the decision for treatment. [ABSTRACT FROM AUTHOR]

The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibia shaft fractures in children weighing 50 kg (110 lb) or more treated by elastic stable intramedullary nailing (ESIN). Translation, sagittal and coronal angulations were assessed on plain radiographs in all the patients. Twenty-six out of 106 patients met the inclusion criteria. The average patient age at the time of injury was 13.5 ± 1.3 years (range 11.3-16.1). The mean patient weight was 57 ± 8 kg (range 50-80). This study demonstrates that the use of ESIN for displaced tibia shaft fractures in children and adolescents weighing 50 kg (110 lb) or more, or older than 13 years of age, is not contraindicated. In contrast to data in femoral shaft fractures, we did not find poorer outcomes in older or heavier patients. No correlation between nail size/medullary canal diameter ratio and outcome was observed. [ABSTRACT FROM AUTHOR]

A retrospective study aims to investigate predisposing factors leading to re-fracture in patients with nails still in place and to identify potential correlations between nail size-to-medullary canal diameter ratio and re-fracture, working to the hypothesis that a higher ratio correlates with a higher risk of re-fracture. Rates of re-fracture with nail still in place after forearm elastic stable intramedullary nailing are higher in younger pediatric patients. Re-fractures occurred at a mean age of 6.7 years (range 5-8.7). While the role of body frame and bone medullary diameter remains unclear, there are grounds for adjusting treatment strategy for age, weight and bone medullary diameter to achieve effective outcome. History of previous forearm fracture and open treatment may also be further risk factors. [ABSTRACT FROM AUTHOR]

Purpose For pediatric femoral shaft fractures, elastic stable intramedullary nailing (ESIN) is an accepted method of treatment. But problems regarding stability with shortening or axial deviation are well known in complex fracture types and heavier children. Biomechanical in vitro testing was performed to determine whether two modified osteosyntheses with an additional tension screw fixation or screw fixation alone without nails could significantly improve the stability in comparison to classical ESIN. Methods A total of 24 synthetic adolescent-sized femoral bone models (Sawbones, 4th generation; Vashon, Washington, United States) with an identical spiral fracture (length 100mm) were used. All grafts underwent retrograde fixation with two C-shaped steel nails (2C). Of the 24, 8 osteosyntheses were supported by one additional tension screw (2C1S) and another 8 by two screws (2S) in which the intramedullary nails were removed before testing. Each configuration underwent biomechanical testing in 4-point bending, external rotation (ER) and internal rotation (IR). Furthermore, the modifications were tested in axial physiological 9 degrees position for shifting and dynamic compression as well as dynamic load. Results Both screw configurations (2C1S and 2S) demonstrated a significantly higher stability in comparison to the 2C configuration in 4-point bending (anterior-posterior, 0.95 Nm/mm [2C] < 8.41 Nm/mm [2C1S] and 15.12 Nm/mm [2S]; posterior-anterior, 8.55 Nm/mm [2C] < 12.65 Nm/mm [2C1S] and 17.54 Nm/mm [2S]; latero-medial, 1.17 Nm/mm [2C] < 5.53 Nm/mm [2C1S] and 9.15 Nm/mm [2S]; medio-lateral, 1.74 Nm/mm [2C] < 9.69 Nm/mm [2C1S] and 12.20 Nm [2S]; all p < 0.001) and during torsion (ER, 0.61 Nm/degree [2C] < 4.10 Nm/degree [2C1S] and 9.29 Nm/degree [2S]; IR, 0.18 Nm/degree [2C] < 6.17 Nm/degree [2C1S] and 10.61 Nm/degree [2S]; all p < 0.001]. The shifting in compression in 9 degrees position was only slightly influenced. The comparison of 2S versus 2C1S showed more stability for 2S than 2C1S in all testing, except the axial 9 degrees compression tests for shifting. In contrast to the 2C configuration, both modifications (2C1S and 2S) turned out to be stable in dynamic 9 degrees axial compression with a force of 100 up to 1,000 N at 2.5 Hz in 250,000 load cycles. Conclusions In this in vitro adolescence femur spiral fracture model, the stability of ESIN could be significantly improved by two modifications with additional tension screws. If transferred in clinical practice, these modifications might offer earlier weight bearing and less problems of shortening or axial deviation. [ABSTRACT FROM AUTHOR]

Background: Elastic stable intramedullary nailing (ESIN) is accepted widely for treatment of diaphyseal femur fractures in children. However, complication rates of 10 to 50 % are described due to shortening or axial deviation, especially in older or heavier children. Biomechanical in vitro testing was performed to determine whether two modified osteosyntheses with end caps or a third nail could significantly improve the stability in comparison to classical elastic stable intramedullary nailing in a transverse femur fracture model. Methods: We performed biomechanical testing in 24 synthetic adolescent femoral bone models (Sawbones®) with a transverse midshaft (diaphyseal) fracture. First, in all models, two nails were inserted in a C-shaped manner (2 x 3.5 mm steel nails, prebent), then eight osteosyntheses were modified by using end caps and another eight by adding a third nail from the antero-lateral (2.5-mm steel, not prebent). Testing was performed in four-point bending, torsion, and shifting under physiological 9° compression. Results: The third nail from the lateral showed a significant positive influence on the stiffness in all four-point bendings as well as in internal rotation comparing to the classical 2C configuration: mean values were significantly higher anterior-posterior (1.04 vs. 0.52 Nm/mm, p < 0.001), posterior-anterior (0.85 vs. 0.43 Nm/mm, p < 0.001), lateral-medial (1.26 vs. 0.70 Nm/mm, p < 0.001), and medial-lateral (1.16 vs. 0.76 Nm/mm, p < 0.001) and during internal rotation (0.16 vs. 0.11 Nm/°, p < 0.001). The modification with end caps did not improve the stiffness in any direction. Conclusions: The configuration with a third nail provided a significantly higher stiffness than the classical 2C configuration as well as the modification with end caps in this biomechanical model. This supports the ongoing transfer of the additional third nail into clinical practice to reduce the axial deviation occurring in clinical practice. [ABSTRACT FROM AUTHOR]

Fractures of the lower extremities in children and adolescents are common injuries and the lower leg is more often affected than the upper leg. There are many more recommendations for the treatment of femoral shaft fractures than for treatment of lower leg shaft fractures. Femoral shaft fractures in young children are the domain of conservative treatment. For the upper and lower leg, elastic stable intramedullary nailing (ESIN) is frequently used as the operative procedure up to a body weight of 50kg; however, plate osteosynthesis represents a serious alternative. The advantages of ESIN are the small access route and more rapid load-bearing. For simple transverse fractures the intramedullary stabilization is clearly superior. The disadvantage of ESIN is the high intraoperative radiation exposure. Plate osteosynthesis can also be carried out in a minimally invasive way and longer areas of fragmentation can be effectively bridged. [ABSTRACT FROM AUTHOR]

Purpose: Displaced proximal humerus fractures within the pediatric population can be treated by elastic stable intramedullary nailing (ESIN). The main objective of our study is to evaluate functional outcome of the displaced proximal humeral fractures treated by ESIN within the pediatric group using a standardized evaluation scale. The secondary goal is to compare functional outcome of epiphyseal and metaphyseal injuries and functional outcome of children younger and older than 10 years of age. Materials and methods: From March 2010 to December 2011, 27 children had been treated surgically using ESIN for displaced fractures at the proximal extremity of the humerus. These fractures were displaced and closed without neurovascular insult. Patients were followed radiographically and clinically on a regular basis. After hardware removal, the functional outcomes had been homogeneously assessed by using the French edition of the QuickDash evaluation scale. The descriptive statistics including mean, standard deviation, and confidence interval have been realized. Results: We included 27 children who were operated on consecutively (10 boys, 17 girls). The mean age at the time of operation is 11.2 ± 2.7 years (range 7.1-15.9). The mean angulation is 55.9° ± 20.3° (range 20-90). The mean apposition is 52.8 % ± 33.1 (range 10-100). The mean follow-up period is 15.2 ± 5.6 months (range 6.1-28.5). Results were considered good for children between 7.1 and 15.9 years old with epiphyseal and meataphyseal fractures. The mean QuickDash score is 2.0 (range 0-6.5), with 14 cases showing a score of 0 (58.3 %), 2 cases with 4.3 (8.3 %), 4 cases with 4.5 (16.7 %), and 4 cases with a score of 6.5 (16.7 %). Ranges of movement were preserved. The patients regained their daily and sportive activity over the time without pain or discomfort. Conclusion: Our study showed a good outcome of functional results within a pediatric population who had a sustained displaced proximal humeral fracture and treated by ESIN. Using a standardized evaluation scale is recommended in order to be able to evaluate the patients in a homogeneous manner. [ABSTRACT FROM AUTHOR]

Background Elastic stable intramedullary nailing (ESIN) is the standard treatment for displaced diaphyseal femoral fractures in children. However, high complication rates (10-50%) are reported in complex fractures. This biomechanical study compares the stiffness with a 3rd nail implanted to that in the classical 2C-shaped configuration and presents the application into clinical practice. Methods For each of the 3 configurations of ESIN-osteosynthesis with titanium nails eight composite femoral grafts (Sawbones®) with an identical spiral fracture were used: 2C configuration (2C-shaped nails, 2× 3.5 mm), 3CM configuration (3rd nail from medial) and 3CL configuration (3rd nail from lateral). Each group underwent biomechanical testing in 4-point bending, internal/ external rotation and axial compression. Results 2C and 3CM configurations showed no significant differences in this spiroid type fracture model. 3CL had a significantly higher stiffness during anterior-posterior bending, internal rotation and 9° compression than 2C, and was stiffer in the lateral-medial direction than 3CM. The 3CL was less stable during p-a bending and external rotation than both the others. As biomechanical testing showed a higher stability for the 3CL configuration in two (a-p corresponding to recurvation and 9° compression to shortening) of three directions associated with the most important clinical problems, we added a 3rd nail in ESIN-osteosynthesis for femoral fractures. 11 boys and 6 girls (2.5-15 years) were treated with modified ESIN of whom 12 were ‘3CL’; due to the individual character of the fractures 4 patients were treated with ‘3CM’ (third nail from medial) and as an exception 1 adolescent with 4 nails and one boy with plate osteosynthesis. No additional stabilizations or re-operations were necessary. All patients achieved full points in the Harris-Score at follow-up; no limb length discrepancy occurred. Conclusion The 3CL configuration provided a significantly higher stiffness than 2C and 3CM configurations in this biomechanical model. These results were successfully transmitted into clinical practice. All children, treated by 3CL or 3CM according to the individual character of each fracture, needed no additional stabilization and had no Re-Do operations. As a consequence, at our hospital all children with femoral diaphyseal fractures with open physis are treated with this modified ESIN-technique. [ABSTRACT FROM AUTHOR]

Introduction: The elastic stable intramedullary nailing (ESIN) presently seems the best technique in the surgical treatment of femoral shaft fractures (FSF) in >6-year-old children. We hereby report technical difficulties and therapeutic results after our first 8 years of experience. Patients and Methods: It's a retrospective study over a period of 8 years from January 2005 to December 2012 in the Paediatric Surgery Department of Sylvanus Olympio Teaching Hospital of Lomé. Indications, technical particularities and results were studied. Results: There were 32 patients, 17 were boys and 15 were girls, with a mean age of 11 years old. The mean time to surgery was 21 days (range: 14 and 51 days). A callus was always removed before reduction. The osteosynthesis was stable in 22 cases, but in 10 others, it had been completed with a cast immobilisation. The operation needed a blood transfusion in 18 cases. With a mean followup of 3.5 years, the results were excellent in 29 patients (90.63%) and good in 3 patients (9.37%). Conclusion: Although undertaking an ESIN can be difficult, due to the lack of adequate equipment the procedure produces satisfactory outcome. [ABSTRACT FROM AUTHOR]

Background: Tibial shaft fractures in children must be treated taking into consideration the fracture location, which may also present specific complications. Conservative treatment: In most cases, so-called nondisplaced fractures can be treated conservatively by immobilization in a cast. Conservative or operative treatment: The rare proximal metaphyseal fracture of the primary valgus will develop a secondary valgus deformity and has to be adequately reduced by means of a cast or osteosynthesis. Fractures of both tibia and fibula may be conservatively treated as long as there is a good bony contact; however, older children may benefit from an elastic stable intramedullary nailing (ESIN). Operative treatment: Isolated shortened tibial fractures tend to a varus deformity which can be prevented by external fixation. In unstable distal metaphyseal fractures, any fixation method (e.g., ESIN, fixateur or, in very distal fractures, wires) can be used. Open fractures and compartment syndrome are treated as in adults. [ABSTRACT FROM AUTHOR]

Introduction Elastic stable intramedullary nailing (ESIN) is the first-choice surgical technique for stabilizing various pediatric diaphyseal and selected metaphyseal fractures of the long bones. This technique has increasingly been applied in fractures of the small bones. Here, we report experiences with ESIN in displaced fractures of the metacarpals in children. Patients and Methods Retrospective data analysis of metacarpal fractures in children stabilized by ESIN in three pediatric trauma centers between 2003 and 2009. Indication for intervention was total displacement or axial deviation >10 degrees in the frontal plane and/or >30 degrees in the sagittal view. Results A total of 66 cases of metacarpal fractures (51 right hand and 12 left hand) treated by ESIN were found in 63 children (mean age 13.3 years; range 4.0 to 16.1) over the study period. Of these, 55 fractures affected metacarpal 5, 6 fractures affected metacarpal 4, 3 fractures affected metacarpal 1, and 2 fractures occurred at metacarpal 2. Mean operating time was 21 minutes (range 5 to 54), titanium elastic nails were used with a diameter of 1.5 mm (n = 23), 2.0 mm (n = 42), and 2.5 mm (n = 1). Single ESIN implantation was performed in 63 cases; in 3 cases, two nails were implanted. Eleven patients received additional immobilization due to nondisplaced additional fractures of the phalanx (n = 2) or for analgetic treatment (n = 9). Five complications were registered (7.6%). In two cases recurrent fracture dislocation occurred, one of themrequiring revision of the osteosynthesis. In other two cases irritation of the extensor tendons occurred, one of them requiring secondary tendon plasty. One persisting cutaneous hyposensibility after ESIN of a metacarpal 5 fracture was reported. All fractures healed uneventfully and metal removal was performedafter amean of 92 days (range 31 to 104). After amean follow-up of 26 months (range 2 to 74), all patients had full range of movement and cosmetic results were described as good and satisfactory by all patients. Conclusion ESIN of the metacarpals is a safe, minimally invasive, and technically easy option in displaced fractures that warrant surgical intervention achieving excellent longterm results. Complications occurred when technical aspects to obtain stability were neglected or tendons and nerves of the hand had been injured. Stabilizing fractures of metacarpal 1 is technically challengingwhen compared with fractures ofmetacarpals 2 to 5. [ABSTRACT FROM AUTHOR]

Abstract: Background: Flexible intramedullary nail fixation of dislocated diaphyseal femur fractures has gained wide acceptance for children and adolescents with open physes. Studies with a special emphasis on complications reveal frequent problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing >40kg. This biomechanical study analyses how much the material of the nails influences the stiffness in a synthetic bone model. Methods: Twenty-four composite grafts (Sawbones®, 4th generation, medullar canal of 10mm) with an identical spiral fracture were used in three configurations of eight grafts. Elastic stable intramedullary nailing was performed in a retrograde C-shaped manner with two nails of equal size (2×3.5mm). Close contact of the fragments could be achieved. We compared Group A (steel nails) with Group B and C (two types of titanium nails). All specimens underwent 4-point bending, torsion and axial compression in the 0° and 9° positions, and the results were analysed. Findings: Group A (steel nails) revealed a significantly higher stiffness in all directions than Group B. Apart from compression in the 9° position this steel nail fixation showed significant higher stiffness than titanium nails of Group C. Comparing Group B and C did not show an systematic difference. Interpretation: In this biomechanical study with composite artificial bones the use of steel Nails demonstrated the highest stiffness in our model when compared to two different titanium nail configurations. Apart from in cases of known allergy or planned MRI-examinations our results and data from the literature question the use of titanium nails. [Copyright &y& Elsevier]

Context: Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. Aim: To report our experience with this current technique of management of fractures in children. Methods and Materials: A retrospective study of all children with fractures treated by this method from November 2003 to June 2006 at the Paediatric Surgery Department of Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire. Data were recorded from their medical charts regarding demographics, fracture patterns, associated injuries, morbidity, and outcome. Results: A total of 38 children (14 boys; mean age, 11.7 years; range, 9-15 years) with 41 fractures, sited at femur (n=15), humerus (n=8), tibia and fi bula (n=6), forearm (n=7), and radial neck (n=5), associated with other injuries in 7 cases, were enrolled in the study. The mean interval for surgery was 6.8 days. Open reduction was required 5 times (12.1%). The hospital stay was in the range 5-12 days. Minor adverse events were 1 (2.4%) early tibial loss of reduction, 3 (7.3%) skin irritations and 2 (4.8%) transient knee limitations. Complications (17.3%) included 2 axial (4.8%) and 1 rotational (2.4%) femoral malunions below 15°; 3 elbow (7.3%) and 1 knee stiffness (2.4%) in openly reduced cases. Solid consolidation was achieved in all cases, with no disturbance in standard union times. At a mean follow-up period of 16 months (range, 9-28 months), all but 3 patients with opened joints recovered full range of motion, and none showed either limp and gait anomalies or re-fracture after removal of wires. Conclusion: Elastic stable intramedullary nailing in children fractures is easy to perform and has little complications if a proper technique is used. [ABSTRACT FROM AUTHOR]

Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture. [ABSTRACT FROM AUTHOR]

For child-oriented treatment of fractures it is important to consider healing processes specific to children. These healing processes necessitate early treatment and a primary definitive treatment concept in line with current standards. The parents or guardians of the child should be directly included while obtaining the anamnesis, for the diagnosis and when planning the treatment concept. Specifically, the potential of spontaneous correction of the growing bone and the necessity or avoidance of imaging procedures should be thoroughly discussed. For the treatment of shaft fractures of the long bones the method of elastic stable intramedullary nailing has found common acceptance as this method significantly reduces both the duration of inpatient treatment as well as the time of immobilization. The child-oriented treatment of fractures is still in development and demands specific knowledge of the orthopedic surgeon concerning the characteristics of the growing bones, the potential of spontaneous correction and the outcome of injuries to the growth plate on the growing skeleton. [ABSTRACT FROM AUTHOR]

Background: Both-bone forearm fractures are a common fracture, accounting for 3.4% of all paediatric fractures. For now, elastic stable intramedullary nailing (ESIN) and open reduction and internal fixation (ORIF) are the common surgical procedures for paediatric both-bone forearm fractures. Both ORIF and ESIN have their shortcomings. Therefore, we need to find another surgical treatment which can decrease the rate of complications and improve the clinical efficacy. Our study plans to test hybrid fixation, using an ESIN fixation for the radius and an ORIF for the ulna. Our study will conduct a randomised controlled trial (RCT) comparing double plate fixation with hybrid fixation for treatment of both-bone forearm fractures in older children between 10 and 16 years of age. The objectives of this trial are to compare the effectiveness between double plate fixation and hybrid fixation for treatment of both-bone forearm fractures in older children.Methods: An RCT will be conducted, and the participants included will be randomly divided into either the hybrid fixation group or the double plate fixation group, at a ratio of 1:1. The primary clinical outcome measures are the Disabilities of the Arm, Shoulder and Hand score and radiological evaluation. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery and complications. Follow-up will be conducted at 2 weeks and 1, 3, 6 and 12 months postoperatively.Discussion: The trial will provide a new surgical treatment for forearm fractures in older children. Our hypothesis is that there is no clinically relevant difference in the primary outcome measures between the two treatment groups.Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800018060. Registered on 26 August 2018. [ABSTRACT FROM AUTHOR]