Elastic Stable Intramedullary Nail: The viable technique for pediatric long bone fixation
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Published:
Apr 30, 2014
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Abstract
Treatment options for a pediatric diaphyseal fracture have been debated for a long time. Cast immobilization is used as a nonsurgical treatment to avoid risks from operations. However, casting has disadvantages such as shortening or angulation of the fracture site, difficulty in nursing care, and a delay in the return to school. Internal fixation has been indicated for some patients who cannot encounter those drawbacks. Elastic stable intramedullary nailing (ESIN) is one of the fixations of choice. Rational, surgical techniques and possible complications of ESIN are reviewed in this article. Benefits from this treatment system are that it is a minimally invasive procedure, the promotion of callus formation, easier nursing care, and early ambulation. There are some complications from this technique which were proposed as minor and major complications. Soft tissue irritation around the entry point of the nail is the most common minor complication whereas unacceptable angulation has the highest incidence among major complications.
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References
1. Furlan D, Pogorelic Z, Biocic M, Juric I, Budimir D, Todoric J, et al. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 2011; 100: 208-15.
2. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: Effects of spica cast treatment on family and community. Journal of Pediatric Orthopaedics 1995; 15: 457-60.
3. Martinez AG, Carroll NC, Sarwark JF, Dias LS, Kelikian AS, Sisson Jr GA. Femoral shaft fractures in children treated with early spica cast. Journal of Pediatric Orthopaedics 1991; 11: 712-6.
4. Flynn JM, Hresko T, Reynolds RAK, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: A multicenter study of early results with analysis of complications. Journal of Pediatric Orthopaedics 2001; 21: 4-8.
5. Heybeli M, Muratli HH, Celebi L, Gulcek S, Bicimoglu A. [The results of intramedullary fixation with titanium elastic nails in children with femoral fractures]. Acta orthopaedica et traumatologica turcica 2004; 38(3): 178-87.
6. Lee SS, Mahar AT, Newton PO. Ender nail fixation of pediatric femur fractures: A biomechanical analysis. Journal of Pediatric Orthopaedics 2001; 21: 442-5.
7. Karn MA, Ragiel CA. The psychologic effects of immobilization on the pediatric orthopaedic patient (continuing education credit). Orthopaedic nursing / National Association of Orthopaedic Nurses 1986; 5: 12-7.
8. Sink EL, Faro F, Polousky J, Flynn K, Gralla J. Decreased complications of pediatric femur fractures with a change in management. Journal of Pediatric Orthopaedics 2010; 30: 633-7.
9. Heinrich SD, Drvaric D, Darr K, MacEwen GD. Stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails (a technique paper). Journal of orthopaedic trauma. 1992; 6: 452-9.
10.Anglen JO, Choi L. Treatment options in pediatric femoral shaft fractures. Journal of orthopaedic trauma 2005; 19: 724-33.
11. Parsch KD. Modern trends in internal fixation of femoral shaft fractures in children. A critical review. Journal of Pediatric Orthopaedics Part B 1997; 6: 117-25.
12. Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. Journal of Pediatric Orthopaedics 2004; 24: 363-9.
13. Perez A, Mahar A, Negus C, Newton P, Impelluso T. A computational evaluation of the effect of intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Medical Engineering and Physics 2008; 30: 755-60.
14. Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH. Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures. Journal of Bone and Joint Surgery - Series A 2008; 90: 1305-13.
15. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of bone and joint surgery British volume 1988; 70: 74-7.
16. Olerud S, Stark A, Gillstrom P. Malrotation following Ender nailing. Clinical Orthopaedics and Related Research 1980; 147: 139-42.
17. Balakumar B, Natarajan MV. Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up? Journal of pediatric orthopedics Part B 2013; 22: 101-5.
18. Chitgopkar SD. Flexible Nailing of fractures In children using stainless steel Kirschner wires. Journal of Pediatric Orthopaedics Part B 2008; 17: 251-5.
19. Mahar A, Sink E, Faro F, Oka R, Newton PO. Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter. Journal of Children's Orthopaedics 2007; 1: 211-5.
20. Green JK, Werner FW, Dhawan R, Evans PJ, Kelley S, Webster DA. A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fractures. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2005; 23: 1315-20.
21. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE. Complications of titanium elastic nails for pediatric femoral shaft fractures. Journal of pediatric orthopedics 2003; 23: 443-7.
22. Gwyn DT, Olney BW, Dart BR, Czuwala PJ. Rotational control of various pediatric femur fractures stabilized with titanium elastic intramedullary nails. Journal of pediatric orthopedics 2004; 24: 172-7.
23. Kaiser MM, Wessel LM, Zachert G, Stratmann C, Eggert R, Gros N, et al. Biomechanical analysis of a synthetic femur spiral fracture model: Influence of different materials on the stiffness in flexible intramedullary nailing. Clinical Biomechanics 2011; 26: 592-7.
24. Li Y, Stabile KJ, Shilt JS. Biomechanical analysis of titanium elastic nail fixation in a pediatric femur fracture model. Journal of pediatric orthopedics 2008; 28: 874-8.
25. Kiely N. Mechanical properties of different combinations of flexible nails in a model of a pediatric femoral fracture. Journal of Pediatric Orthopaedics 2002; 22: 424-7.
26. Barry M, Paterson JM. A flexible intramedullary nails for fractures in children. The Journal of bone and joint surgery British volume 2004; 86: 947-53.
27. Nectoux E, Giacomelli MC, Karger C, Gicquel P, Clavert JM. Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: Preliminary results in 11 fractures. Journal of Children's Orthopaedics 2008; 2: 309-14.
28. Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: A comparison of fracture types. Journal of Pediatric Orthopaedics 2005; 25: 577-80.
29. Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. The Journal of bone and joint surgery British volume 2006; 88: 1361-6.
30. Bandyopadhyay R, Mukherjee A. Short term complications of titanium elastic nail in the treatment of diaphyseal fracture of the femur in children. The open orthopaedics journal 2013; 7: 12-7.
31. Wall L, O'Donnell JC, Schoenecker PL, Keeler KA, Dobbs MB, Luhmann SJ, et al. Titanium elastic nailing radius and ulna fractures in adolescents. Journal of pediatric orthopedics Part B 2012; 21: 482-8.
32. Doser A, Helwig P, Konstantinidis L, Kuminack KF, Sudkamp NP, Strohm PC. Does the extent of prebending affect the stability of femoral shaft fractures stabilized by titanium elastic nails? A biomechanical investigation on an adolescent femur model. Journal of pediatric orthopedics 2011; 31: 834-8.
33. Salem KH, Keppler P. Limb geometry after elastic stable nailing for pediatric femoral fractures. Journal of Bone and Joint Surgery - Series A 2010; 92: 1409-17.
2. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: Effects of spica cast treatment on family and community. Journal of Pediatric Orthopaedics 1995; 15: 457-60.
3. Martinez AG, Carroll NC, Sarwark JF, Dias LS, Kelikian AS, Sisson Jr GA. Femoral shaft fractures in children treated with early spica cast. Journal of Pediatric Orthopaedics 1991; 11: 712-6.
4. Flynn JM, Hresko T, Reynolds RAK, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: A multicenter study of early results with analysis of complications. Journal of Pediatric Orthopaedics 2001; 21: 4-8.
5. Heybeli M, Muratli HH, Celebi L, Gulcek S, Bicimoglu A. [The results of intramedullary fixation with titanium elastic nails in children with femoral fractures]. Acta orthopaedica et traumatologica turcica 2004; 38(3): 178-87.
6. Lee SS, Mahar AT, Newton PO. Ender nail fixation of pediatric femur fractures: A biomechanical analysis. Journal of Pediatric Orthopaedics 2001; 21: 442-5.
7. Karn MA, Ragiel CA. The psychologic effects of immobilization on the pediatric orthopaedic patient (continuing education credit). Orthopaedic nursing / National Association of Orthopaedic Nurses 1986; 5: 12-7.
8. Sink EL, Faro F, Polousky J, Flynn K, Gralla J. Decreased complications of pediatric femur fractures with a change in management. Journal of Pediatric Orthopaedics 2010; 30: 633-7.
9. Heinrich SD, Drvaric D, Darr K, MacEwen GD. Stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails (a technique paper). Journal of orthopaedic trauma. 1992; 6: 452-9.
10.Anglen JO, Choi L. Treatment options in pediatric femoral shaft fractures. Journal of orthopaedic trauma 2005; 19: 724-33.
11. Parsch KD. Modern trends in internal fixation of femoral shaft fractures in children. A critical review. Journal of Pediatric Orthopaedics Part B 1997; 6: 117-25.
12. Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. Journal of Pediatric Orthopaedics 2004; 24: 363-9.
13. Perez A, Mahar A, Negus C, Newton P, Impelluso T. A computational evaluation of the effect of intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Medical Engineering and Physics 2008; 30: 755-60.
14. Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH. Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures. Journal of Bone and Joint Surgery - Series A 2008; 90: 1305-13.
15. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of bone and joint surgery British volume 1988; 70: 74-7.
16. Olerud S, Stark A, Gillstrom P. Malrotation following Ender nailing. Clinical Orthopaedics and Related Research 1980; 147: 139-42.
17. Balakumar B, Natarajan MV. Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up? Journal of pediatric orthopedics Part B 2013; 22: 101-5.
18. Chitgopkar SD. Flexible Nailing of fractures In children using stainless steel Kirschner wires. Journal of Pediatric Orthopaedics Part B 2008; 17: 251-5.
19. Mahar A, Sink E, Faro F, Oka R, Newton PO. Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter. Journal of Children's Orthopaedics 2007; 1: 211-5.
20. Green JK, Werner FW, Dhawan R, Evans PJ, Kelley S, Webster DA. A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fractures. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2005; 23: 1315-20.
21. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE. Complications of titanium elastic nails for pediatric femoral shaft fractures. Journal of pediatric orthopedics 2003; 23: 443-7.
22. Gwyn DT, Olney BW, Dart BR, Czuwala PJ. Rotational control of various pediatric femur fractures stabilized with titanium elastic intramedullary nails. Journal of pediatric orthopedics 2004; 24: 172-7.
23. Kaiser MM, Wessel LM, Zachert G, Stratmann C, Eggert R, Gros N, et al. Biomechanical analysis of a synthetic femur spiral fracture model: Influence of different materials on the stiffness in flexible intramedullary nailing. Clinical Biomechanics 2011; 26: 592-7.
24. Li Y, Stabile KJ, Shilt JS. Biomechanical analysis of titanium elastic nail fixation in a pediatric femur fracture model. Journal of pediatric orthopedics 2008; 28: 874-8.
25. Kiely N. Mechanical properties of different combinations of flexible nails in a model of a pediatric femoral fracture. Journal of Pediatric Orthopaedics 2002; 22: 424-7.
26. Barry M, Paterson JM. A flexible intramedullary nails for fractures in children. The Journal of bone and joint surgery British volume 2004; 86: 947-53.
27. Nectoux E, Giacomelli MC, Karger C, Gicquel P, Clavert JM. Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: Preliminary results in 11 fractures. Journal of Children's Orthopaedics 2008; 2: 309-14.
28. Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: A comparison of fracture types. Journal of Pediatric Orthopaedics 2005; 25: 577-80.
29. Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. The Journal of bone and joint surgery British volume 2006; 88: 1361-6.
30. Bandyopadhyay R, Mukherjee A. Short term complications of titanium elastic nail in the treatment of diaphyseal fracture of the femur in children. The open orthopaedics journal 2013; 7: 12-7.
31. Wall L, O'Donnell JC, Schoenecker PL, Keeler KA, Dobbs MB, Luhmann SJ, et al. Titanium elastic nailing radius and ulna fractures in adolescents. Journal of pediatric orthopedics Part B 2012; 21: 482-8.
32. Doser A, Helwig P, Konstantinidis L, Kuminack KF, Sudkamp NP, Strohm PC. Does the extent of prebending affect the stability of femoral shaft fractures stabilized by titanium elastic nails? A biomechanical investigation on an adolescent femur model. Journal of pediatric orthopedics 2011; 31: 834-8.
33. Salem KH, Keppler P. Limb geometry after elastic stable nailing for pediatric femoral fractures. Journal of Bone and Joint Surgery - Series A 2010; 92: 1409-17.