Since the introduction of the Elastic-Stable-Intramedullary-Nailing (abbreviation ESIN) in 1983, by the Nancy group, the method has become a worldwide standard in the treatment of pediatric long bone fractures. When all the biomechanical principles are respected, the vast majority of paediatric long bone diaphyseal fractures can be successfully treated between the ages of 3 and 15 years. The method is particularly suited to management of diaphyseal femoral fractures. Treatment failure of most often occurs when used by inexperienced surgeons in situations where the method is only relatively indicated. Such as the metaphysealdiaphyseal junction or axially unstable injuries, particularly in the taller and/or heavier child. Whilst an expert may achieve success in such circumstances the less experienced surgeon will often resort to more invasive methods. The ESIN method is generally contraindicated for the management of epiphyseal injuries. The commonest reason for failure, even when the method is used for the correct indication, is usually a combination of lack of training, experience and/or technical skill resulting in incorrect execution of the technique and consequently either a suboptimal outcome, where healing is achieved without the benefits of more rapidly achieved reduction, pain relief, healing, return of function and shorter treatment times. Unfortunately these cases are often reported as good outcomes but we should strive for excellence. Worse still poor outcomes are those when poor case selection and/or poor technical execution produces a worse situation than if conservative management had been undertaken.
Slongo T and Dwyer JSM
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