Quadruple ESIN (Elastic Stable Intramedullary Nailing): Modified Treatment in Pediatric Distal Tibial Fractures.

Abstract

Nailing of the tibial shaft with 2 Prevot nails is the gold standard for tibial shaft fractures in children. This technical report aims to show a simple way to stabilize pediatric distal tibial fractures without changing of the operation method. A retrospective chart review of all distal tibial fractures treated with the modified elastic stable intramedullary nailing (ESIN) method during a 6-year period was conducted. The modified ESIN technique hardly differs from the classic method, other than the addition of 2 other Prevot nails inserted using the same entry point. Eight children were treated with the modified ESIN. The mean operation duration was 57 minutes (range, 33 to 88 min). In all cases 2 to 4 mm titanium nails were used. None of our patients required a postoperative cast.Within an average of 14.5 days all of the patients could fully bear their weight (2 to 30 d) and full range of motion was reached. The modified ESIN technique achieves good results regarding stability and early weight-bearing. Therefore, this technique could be applied in unstable distal tibial fractures. Nevertheless, a prospective and biomechanical study is needed to verify our experience. Level IV-therapeutic studies.