Elastic Stable Intramedullary Nailing Group Research Articles

Modified elastic intramedullary nail internal fixation for distal tibial metaphyseal junction fracture.

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. 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. 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. It was concluded that modified elastic stable intramedullary nailing fixation is a safe and effective treatment.

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Comparison of elastic stable intramedullary nailing versus Kirschner wires in treatment of pediatric radial neck fractures.

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. 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. 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. 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 III; Retrospective Comparison; Treatment Study.

Submuscular plating vs. elastic stable intramedullary nailing for diaphyseal femur fractures in children: a systematic review and meta-analysis.

This review evaluates the safety and efficacy of submuscular plating (SMP) vs. elastic stable intramedullary nailing (ESIN) in the treatment of pediatric femur shaft fracture. Studies comparing the efficacy and safety of SMP and ESIN in pediatric shaft fracture were retrieved from five databases (PubMed, Embase, Cochrane, OVID, and Web of Science) from inception to March 2023 using a systematic literature search strategy. A total of 13 outcome measures, such as perioperative parameters, clinical outcomes, and radiographic results, were included in the meta-analysis. Eight eligible studies involving 491 patients were included in the narrative synthesis. There were no significant differences in baseline characteristics between the two groups. Meta-analysis showed reduced radiation time (RT), soft tissue irritation and angular deformation in the SMP group than in the ESIN group. However, the SMP group had greater estimated blood loss (EBL) than the ESIN group. The duration of surgery, length of hospital stay (LOS), implant removal, complications requiring surgery, Flynn score, incidence of infection, fracture healing time, and limb length discrepancy (LLD) were similar between the two groups. Only one study reported higher incidences of fracture nonunion or delayed healing in the ESIN group. SMP is an effective and safe intervention superior to ESIN in reducing soft tissue irritation, angular deformation and radiation time. Given the presence of potential bias and heterogeneity, surgeons should select the treatment that would provide the best outcomes for EBL, LOS, operation time, and bone nonunion or delayed healing based on their experience. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023404118, Identifier PROSPERO (CRD42021228512).

Patient-reported outcomes of adolescents with tibia shaft fractures: comparison of closed reduction and casting vs. elastic stable intramedullary nailing.

Tibial shaft fractures are the third most common pediatric long bone fractures. Closed reduction and casting (CRC) is considered initial treatment in this population, however, surgical management using elastic stable intramedullary nailing (ESIN) is also used in adolescents. This study compared patient-reported outcomes in a cohort of adolescents with tibia fractures treated with ESIN or CRC. This single-center retrospective study gathered adolescent patients 10-18 years of age with closed tibia shaft fractures between the years 2015 and 2021 treated by either CRC or ESIN. Measured outcomes include patient demographics, overall casting time, time to full weight bearing, time to full healing, radiographic healing, complications (loss of reduction, malunion >5° and >10°) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. A total of 141 patients (68% male) were included, with 31 receiving ESIN and 110 having CRC. Patient demographics were similar across groups. At follow-up, CRC had a significant shorter time to healing (11 vs. 15 weeks), but an increased casting duration (7 vs. 4 weeks). Finally, the ESIN group had significantly greater pre-intervention angulation, displacement, and shortening. In both interventions, mobility and pain interference scores showed significant improvements from baseline (2 weeks post-op) at 12, 16, and 24 weeks. No statistically significant differences were noted between CRC and ESIN groups across PROMIS domains of pain interference and mobility. CRC and ESIN are effective in improving pain and mobility in adolescent diaphyseal tibia fractures, but neither intervention is superior based on PROMIS scores at 12, 16 and 24+ weeks. From a patient standpoint, we demonstrate that neither treatment is superior in achieving better-perceived mobility or decreasing pain sooner. Level of Evidence: Level III.

Comparison of three fixation methods in paediatric metaphyseal-diaphysis junction fracture of the distal radius: a retrospective study in two centres.

The distal radial metaphyseal-diaphysis junction fractures (DRMDJ) have various treatment methods and are easily lead to complications. This study aims to compare the anterograde elastic stable intramedullary nailing (ESIN-A), retrograde K-wire fixation (KW-R), and retrograde precision-shaping elastic intramedullary nailing (ESIN-RPS) for the treatment of pediatric DRMDJ fractures. A total of 113 patients with DRMDJ fractures (36 in the ESIN-A group, 52 in the KW-R group, and 25 in the ESIN-RPS group) from two centres were retrospectively analysed. Perioperative operation time, intraoperative bleeding, fluoroscopy times, alignment rate and angulation on radiography were compared among the three groups. Forearm rotation, healing, wrist function, and complications were compared at the last follow-up. The mean operation times of the three groups were as follows: KW-R (72 ± 13 min) > ESIN-A (65 ± 18 min) > ESIN-RPS (52 ± 11 min), with a significant difference (P < 0.01). The incision length and intraoperative blood loss of ESIN-A (1.8 ± 0.2 cm; 8.3 ± 3.7 ml) were significantly higher than ESIN-RPS (1.4 ± 0.8 cm; 5.5 ± 2.7 ml) (P < 0.05), respectively. The postoperative alignment rate on the anteroposterior (AP) and the lateral plane of ESIN-RPS (93.1 ± 4.4%; 95.01 ± 2.8%) was significantly greater than that of KW-R (82.1 ± 6.8%; 88.5 ± 4.5%) and ESIN-A (79.2 ± 5.2%; 83.2 ± 2.5%) (P < 0.01). The residual angulation of ESIN-RPS (3.3 ± 1.2°; 2.9 ± 0.8°) was significantly greater than that for ESIN-A (5.1 ± 1.7°; 4.9 ± 2.1°) and KW-R (6.6 ± 2.8°; 7.5 ± 1.6°) (P < 0.05). The excellent and good ratio of ESIN-RPS (95.8%) was significantly higher than that of ESIN-A (86.5%) and KW-R (86.1%) according to the Gartland-Werley standard. There was a significant difference in delayed union between the KW-R and ESIN-A (P < 0.05). Additionally, there were two cases of radial nerve injury in the ESIN-A group, one case of tendon rupture in the ESIN-RPS group, and one case of tendon rupture in the KW-R group. The ESIN-RPS group had significantly fewer complications than the KW-R group (P < 0.05). The ESIN-A group also had significantly fewer complications than the KW-R group (P < 0.05). Compared with ESIN-A and KW-R, ESIN-RPS has the advantages of a shorter operation time, less intraoperative blood loss, less radiation, better alignment, and fewer complications. The ESIN-RPS was suggested as an optimal choice for paediatric DRMDJ fractures.

Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing.

This retrospective study compared two minimally invasive surgical methods for fifth metacarpal neck fractures in adolescents: percutaneous Kirschner wire (K-wire) fixation and elastic stable intramedullary nailing (ESIN). This study involved 42 adolescents aged 11 to 16 years with fifth metacarpal neck fractures treated by either K-wire fixation (n = 20) or ESIN (n = 22). The palmar tilt angle and shortening were compared on radiographs preoperatively and 6 months postoperatively. Total active range of motion (TAM), the visual analogue scale score for pain, and the Disabilities of the Arm, Shoulder and Hand score for upper limb function were recorded at 5 weeks, 3 months, and 6 months postoperatively. The mean TAM was significantly greater in the ESIN than K-wire group at all postoperative time points. The mean external fixation time was 2 weeks longer in the K-wire than ESIN group. One patient in the K-wire group developed infection. There was no statistically significant difference between the two groups in other postoperative outcomes. ESIN fixation has the advantages of greater stability, better activity, a shorter external fixation time, and a lower infection rate than K-wire fixation in the treatment of fifth metacarpal neck fractures in adolescents.

Diaphyseal Femur Fractures in Children and Adolescents-Opportunities and Limitations of the ESIN Technique.

Background: Elastic stable intramedullary nailing (ESIN) is the gold standard for non-overweight children aged 6−12 years. However, the complication rate using elastic stable intramedullary nailing is considerably high. Nevertheless, the question arises of whether the indication for elastic stable intramedullary nailing therapy can be extended and which factors must be taken into account when determining the indication. Methods: A retrospective chart review of patients <18 years admitted with diaphyseal femur fracture at a Level I Trauma Center in Germany between 2005 and 2017 was performed. In total, 118 patients were included. For the classification of femur fractures in children, the AO Pediatric Comprehensive Classification of Long-Bone Fractures (AO-PCCF) was applied. Results: Simple oblique fractures (32-D/5.1) occurred in most of the patients. Patients with simple oblique fractures were significantly younger compared to patients with simple transverse (32-D/4.1) or multifragmentary (32-D/5.2) fracture type according to the AO Pediatric Comprehensive Classification of Long-Bone Fractures. Most patients were treated with elastic stable intramedullary nailing (68 patients, 58%). Although children treated with elastic stable intramedullary nailing were older than those treated conservatively (25%, n = 29, mean age 1.5, median age 1.0), the children in the elastic stable intramedullary nailing group were comparatively young (range 1−12 years, mean age 5.4, median age 5). A total of 32 children below the age of 6 years were treated with elastic stable intramedullary nailing. Complications were more frequent in patients with overhead extension (50%) compared to conservative treatment with a spica cast (17%) or elastic stable intramedullary nailing (15%). Conclusions: Elastic stable intramedullary nailing therapy was associated with a low complication rate and was, therefore, a safe and frequently used treatment strategy in diaphyseal femur fractures with satisfactory results, even though the age groups were expanded in favor of younger patients.

Clinical Efficacy of Minimally Invasive Elastic Stable Intramedullary Nailing for Limb Long Bone Fractures in Children.

ObjectiveThe aim of the present paper was to investigate the clinical efficacy of minimally invasive elastic stable intramedullary nailing (ESIN) for long bone fractures in children.MethodsA total of 350 children with limb fractures from June 2012 to June 2018 were recruited and randomized into two groups: an ESIN group (n = 175) treated with elastic stable intramedullary nailing, and an MPIF group (n = 175), treated with metal plate internal fixation. Both groups received the same physical examination and routine medication. Operation related indexes, clinical efficacy, complications, and postoperative quality of life scores were analyzed and compared.ResultsThe operation time, intraoperative blood loss, hospitalization time, and fracture healing time in the ESIN group were 43.74 ± 4.96 min, 8.14 ± 1.34 mL, 5.97 ± 1.88 days, and 55.89 ± 5.61 days, respectively, which were all significantly less than those in the MPIF group (all P < 0.001). In terms of common complications after limb fracture treatment, there were 6 cases of osteomyelitis, 5 cases of skin irritation response, and 7 cases of inflammatory granuloma in the MPIF group. There were 2 cases of skin irritation response and 5 cases of inflammatory granuloma in the ESIN group. The incidence of postoperative complications in the ESIN group was 4.00%, which was significantly lower than that in MPIF group (10.29%) (P < 0.05). The effective rate for recovery condition in the ESIN group (93.71%) was significantly higher than that in the MPIF group (P < 0.001). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (79.43%) (P < 0.001). The postoperative satisfaction rate in the ESIN group (94.29%) was significantly higher than that in the MPIF group (86.29%) (P < 0.05). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (P < 0.001). The postoperative satisfaction rate and the acceptance rate for adjacent joint function in the ESIN group (100%) were significantly higher than those in the MPIF group (92.00%) (P < 0.0001).ConclusionElastic stable intramedullary nailing is a minimally invasive procedure for long bone fractures in children. It can effectively improve the operation‐related indicators and postoperative quality of life and reduce the incidence of complications.

Traitement des fractures de la diaphyse fémorale de l’enfant comparant embrochage élastique stable versus fixateur externe : méta-analyse

BackgroundThere is currently a debate about whether elastic stable intramedullary nails (ESIN) or external fixation (EF) is the best surgical method for treating pediatric femoral shaft fractures. We performed a meta-analysis to determine which surgical method leads to higher treatment satisfaction, lower complication rates, and reduced treatment time, to investigate whether ESIN is the preferred surgical method for treatment of pediatric femoral shaft fractures. Patients and methodsRelevant databases were searched for comparative studies of ESIN versus EF for the treating pediatric femoral shaft fractures. Literature reports and quality evaluations were extracted, followed by a systematic review using RevMan 5.3 software. Treatment satisfaction at the last follow-up, primary complications, secondary complications, and relevant time indicators (operation time, hospital stay, clinical healing time, bone healing time) were analyzed. ResultsA total of 22 reports were included in this meta-analysis. We found no statistical differences in the treatment satisfaction at the last follow-up between ESIN and EF for the treatment of pediatric femoral shaft fractures. A low rate of post-operative re-fracture (RR=3.58, 95% CI [1.85, 6.92], p=0.0001) and postoperative infection (RR=9.25, 95% CI [5.32, 16.11], p<0.00001), and a high risk of skin irritation (RR=0.15, 95% CI [0.06, 0.37], p<0.00001) were found in the ESIN group. No significant differences between the two approaches were found regarding malunion. A low rate of limb-length discrepancy (RR=2.41, 95% CI [1.40, 4.17], p=0.002), hospitalization (SMD=0.84, 95% CI [0.24, 1.43], p=0.006), clinical healing time (SMD=0.95, 95% CI [0.56, 1.33], p<0.00001) and bone healing time (SMD=0.89, 95% CI [0.39, 1.40], p=0.005) were found in the ESIN group, as compared to that in the EF group. No significant differences were found in fixation failure, activity limitation of the joint, and operation time between the two strategies. DiscussionESIN should be the primary choice for the treatment of pediatric femoral shaft fractures since it has a reliable curative effect and results in a shorter hospital stay, faster fracture healing, and fewer complications. EF is recommended for fractures with serious injury of the soft tissue to avoid intramedullary infection. Double-blind high-quality randomized studies with larger sample sizes are warranted to confirm our conclusions. Level of evidenceIV.

Treatment of pediatric femoral shaft fractures with elastic stable intramedullary nails versus external fixation: A meta-analysis

BackgroundThere is currently a debate about whether elastic stable intramedullary nails (ESIN) or external fixation (EF) is the best surgical method for treating pediatric femoral shaft fractures. We performed a meta-analysis to determine which surgical method leads to higher treatment satisfaction, lower complication rates, and reduced treatment time, to investigate whether ESIN is the preferred surgical method for treatment of pediatric femoral shaft fractures. Patients and methodsRelevant databases were searched for comparative studies of ESIN versus EF for the treating pediatric femoral shaft fractures. Literature reports and quality evaluations were extracted, followed by a systematic review using RevMan 5.3 software. Treatment satisfaction at the last follow-up, primary complications, secondary complications, and relevant time indicators (operation time, hospital stay, clinical healing time, bone healing time) were analyzed. ResultsA total of 22 reports were included in this meta-analysis. We found no statistical differences in the treatment satisfaction at the last follow-up between ESIN and EF for the treatment of pediatric femoral shaft fractures. A low rate of postoperative re-fracture (RR=3.58, 95% CI (1.85, 6.92), p=0.0001) and postoperative infection (RR=9.25, 95% CI (5.32, 16.11), p<0.00001), and a high risk of skin irritation (RR=0.15, 95% CI (0.06, 0.37), p<0.00001) were found in the ESIN group. No significant differences between the two approaches were found regarding malunion. A low rate of limb-length discrepancy (RR=2.41, 95% CI (1.40, 4.17), p=0.002), hospitalization (SMD=0.84, 95% CI (0.24, 1.43), p=0.006), clinical healing time (SMD=0.95, 95% CI (0.56, 1.33), p<0.00001) and bone healing time (SMD=0.89, 95% CI (0.39, 1.40), p=0.005) were found in the ESIN group, as compared to that in the EF group. No significant differences were found in fixation failure, activity limitation of the joint, and operation time between the two strategies. DiscussionESIN should be the primary choice for the treatment of pediatric femoral shaft fractures since it has a reliable curative effect and results in a shorter hospital stay, faster fracture healing, and fewer complications. EF is recommended for fractures with serious injury of the soft tissue to avoid intramedullary infection. Double-blind high-quality randomized studies with larger sample sizes are warranted to confirm our conclusions. Level of evidenceIV.

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

ObjectiveStudies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. MethodsTotally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up. ResultsESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. ConclusionESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.

Elastic stable intramedullary nailing versus Kirschner wire pinning: outcome of severely displaced proximal humeral fractures in juvenile patients

Significantly displaced juvenile proximal humeral fractures (Neer-Horowitz type 3 and 4) usually require reduction and fixation. The most commonly used fixation methods are Kirschner wire (K-wire) pinning or retrograde elastic stable intramedullary nailing (ESIN). However, results comparing the long-term outcome of both methods are absent in the literature. The aim of this study was to provide an outcome comparison of both techniques. Included were 40 patients treated between 1998 and 2008 and who had complete records concerning operation time, duration of hospital stay, and time until implant removal. The assessment of clinical (Disabilities of Arm, Shoulder and Hand [DASH] and Constant-Murley scores) and radiologic long-term outcome was possible in 31 patients (78%). Preoperative, postoperative and follow-up radiographs of these patients were evaluated for angular deformity, reduction, and remodeling. The mean follow-up of the 31 patients (16 ESIN; 15 K-wire) was 5.8 ± 3.6 (standard deviation) years. The operative time of the primary fixation procedure was shorter in the ESIN group (P < .001), but the hospital stay and the time until implant removal were significantly longer. No significant difference was seen between the groups at follow-up for the mean DASH (ESIN, 1.44; K-wire, 1.66) or Constant-Murley (ESIN, 89.5; K-wire, 92) scores. The neck-shaft angle was significantly improved by reduction in both groups (P < .001) and remained unchanged at follow-up. ESIN and K-wire pinning have a favorable and comparable functional outcome and therefore seem to be adequate methods for treating Neer-Horowitz type 3 and 4 proximal humeral fractures in juvenile patients. The initially achieved improvement of the neck-shaft angle can be maintained at long-term follow-up.

Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: Early results

A common treatment for pediatric femur fractures is intramedullary nail (IMN) insertion. Elastic stable intramedullary nails (ESINs) are often used for these procedures in heavier patients, but the potential for complications and malunion is greater. We describe here a rigid IMN specifically designed for adolescents, the adolescent lateral entry femoral nail (ALFN). The purpose of this study was to compare the recovery and complications for patients treated with ESINs to those treated with the ALFN. Our study design was a retrospective cohort study. We performed a review of medical records of 22 children ages 10-17 requiring surgical fixation of a femur fracture for a 2½-year period. Patients selected for the study had traumatic diaphyseal femur fractures and were treated with ESINs without end-caps or ALFNs. Our analyses evaluated injury, surgical, and outcome information for all patients. Twenty-two patients were eligible for inclusion and were divided into two groups according to their treatment: the ESIN group with 7 patients and the ALFN group with 15 patients. We then performed a comparison of complications and recovery for these patients. The mean time to full weight-bearing was significantly less for the ALFN group (4.1weeks; SD, 2.2), than the ESIN group (9.4weeks; SD 3.9). There was no statistical difference in the incidence of major or minor complications. Older, heavier pediatric patients treated for femur fracture with ALFNs had a shorter recovery time than similar patients treated with ESINs. However, the outcomes for both groups were satisfactory.

Prospective comparative study of three internal fixation methods for treatment of both-bone forearm fractures in older children

Objective To evaluate and compare the outcomes of three internal fixation methods, ulna compression plate and radial elastic stable intramedullary nailing (ESIN), double ESIN and double plating, for the treatment of both-bone forearm fractures in older children. Methods From February 2004 to July 2008, 45 older children with both-bone forearm fractures that failed manual closed reduction or were unstable were recruited for the prospective comparative study. They were randomized into 3 groups with 15 each: who were treated with ulna compression plate and radial elastic stable intramedullary nailing (ESIN) (group A), double ESIN (group B) and double plating (group C). The intraoperative and perioperative indexes, the radiographic findings, the clinical outcomes and postoperative complications were compared. Results Group A and group B resulted in a lower blood loss and shorter surgery time than group C (statistically significant). However no significant differences were found between group A and group B. There was statistically significant difference on tourniquet use time among the three groups, group B being shorter than group A and group C. There was no significant difference on postoperative pain score within 5 days after the surgery among the three groups. Fracture union rate of group A at 3 months was significantly higher than group B, while no significant differences were found between group B and group C and between group A and group C. There was no statistically significant difference on fracture union among the three groups at 6 months. The incidence of loss of forearm rotation and complications was lower in group A than in group B and group C, however the difference was not statistically significant. Conclusion Based on surgery trauma, incidence of fracture union, clinical outcomes and complications, ulna compression plate and radial elastic stable intramedullary nailing shows superiority in the treatment of both-bone forearm fractures in older children. However double ESIN has the advantages of being minimally invasive and easy for secondary hardware removal. Key words: Fractures; bone; Child; Prospective studies; Literal fiatior

Comparative study of elastic stable intramedullary nailing and bone plate set in treatment of femoral shaft fractures in children

Objective To investigate and evaluate the efficacy of elastic stable intramedullary nailing (ESIN) and bone plate set (BPS) in the treatment of femoral shaft fractures in children. Methods The study involved 39 children with femoral shaft fractures, of whom 18 children were treated with ESIN (ESIN group) and the other 21 with BPS (BPS group). In ESIN group, the nails were insert-ed through a micro incision in the medial and lateral epicondyle after closed reduction under C - arm ob-servation. In BPS group, the plates were placed on the lateral side of femur by means of open reduction and internal fixation. Results All the patients were followed up for 4-20 months (mean 10 months), which showed fracture healing in all the patients. The mean operation time, incision length, perioperative blood loss, length of hospital stay, time of fracture healing and time of weight bearing were (40.0±17.0) minutes, (2.0±0.6) cm, (30.0±8.0) ml, (7.0±1.5) days, (8.0±1.2) weeks and (6.0 ±1.0) weeks respectively in ESIN group, and (70.0±25.0) minutes, (12.0±1.1) cm, (150.0±30.0) ml, (14.0±5.2) days, (13.0±1.9) weeks and (4.0±1.3) weeks respectively in BPS group, with statistical difference between two groups (P < 0.05). Conclusions Compared with BPS, ESIN has the advantages of less operation wound, less perioperative blood loss and shorter time for fracture healing. ESIN can protect the microenvironment important for the fracture healing, and is one of ideal op-tions for treatment of femoral shaft fracture in children. Key words: Femoral fractures; Child; Fracture fixation, intramedallary; Bone plate