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Objective To compare biomechanical characteristics of external fixator, Kirschner’s wire, elastic stable intramedullary nailing (ESIN) for fixing proximal humeral fractures in children by finite element method.Methods The CT scanning data from the healthy humerus of an 8-year-old patient with proximal humeralfractures were collected, and the image data were imported in Mimics 21. 0 to establish the rough humeralmodel, which was imported in Geomagic 2013 to construct the three-dimensional (3D) model of cancellous and cortical bones of the humerus. After the model was assembled with 3 fixators ( external fixator, Kirschner’swire, ESIN), it was imported in ANSYS 2019 to simulate the upper limb under quiet, abduction, adduction, flexion, extension, external rotation, internal rotation working conditions. The maximum displacement of the distal humerus, the maximum stress of the fixture, and the maximum displacement of the distal fracture surface were analyzed. Results The minimum values of the maximum displacement of the distal humerus in models fixed by external fixator, Kirschner’s wire, ESIN appeared under extension (2. 406 mm), external rotation (0. 203 mm), external rotation (0. 185 mm) working conditions, respectively. Conclusions External fixator is the most unstable fixation of proximal humeral fractures in children, and the biomechanical performance of ESIN is better than that of external fixator and Kirschner’s wire fixation
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Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes.
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The elastic stable intramedullary nailing ( ESIN ) technique is widely accepted by pediatric orthopedic surgeons for the following advantages: being minimally invasive, non-destructive on epiphyseal function, easy, rapid postoperative recovery, allowing early functional exercise and having low complication rate. It has become the mainstream technique for the treatment of long bone fractures in children. Although the concept of minimally invasive surgery for children with long bone fractures is constantly evolving and the surgical technique is becoming more and more mature, there are still some complications after ESIN operation, such as tendon and iatrogenic nerve injury, soft tissue irritation and infection, poor alignment after fracture or re-shift, delayed union and non-union, leg-length discrepancy, rotation and angular deformity, osteofascial compartment syndrome, and other clinical problems. These complications often occur due to the negligence of important biological principles, obvious technical errors and the negligence of the characteristics of local anatomy. The authors review the problems of ESIN technique in the treatment of humeral fractures, radius and ulna fractures, femoral fractures and tibial fractures of children, seeking to avoid the complications as much as possible and giving full play to the minimally invasive advantages of ESIN.
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Objective@#To summarize the clinical data of elastic stable intramedullary nailing(ESIN) in the treatment of long bone fracture of children in a single medical center, and to analyze the problems occurred after the ESIN surgery and corresponding solutions.@*Methods@#A retrospective analysis was conducted regarding the clinical data of 2 133 pediatric long bone fractures conforming to inclusion and exclusion criteria from June, 2005 to December, 2017 in Department of Orthopedics, Children′s Hospital of Nanjing Medical University.There were 1 191 boys and 942 girls, aged from 23 months to 14 years with mean age of (5.7 ± 3.1)years.There were 1 866 cases treated with closed reduction with ESIN, while 267 cases were treated with small incision assisted reduction with ESIN.Postoperative problems have been statistically analyzed.@*Results@#There were altogether 2 133 children, including 603 cases of femur, 311 cases of tibia, 8 cases of fibula, 219 cases of humerus, and 992 cases of ulna/radius.The postoperative complications mainly consist of 62 cases of needle tail irritation reaction, 21 cases of misalignments of fracture alignment, 11 cases of intramedullary nail deformity or angular deformity, 7 cases of limb shortening, 14 cases of limited joint activity, 4 cases of nerve injury, 2 cases of tendon injury, 14 cases of difficult nail removal, 4 cases of cortical cleavage, 8 cases of delayed union, 1 case of nonunion, 6 cases of varus/valgus deformity, 5 cases of epiphyseal injury, 6 cases of ESIN exposure, and 2 cases of metal debris of ESIN′ end.@*Conclusions@#The complications of treatment for children with long bone fractures by ESIN cannot be ignored.To master the important biomechanical properties, to get familiar with the local anatomy and to avoid obvious technical errors can reduce the occurrence of postoperative complications.
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Elastic stable intramedullary nailing (ESIN) is a well-accepted fixation method of long bone fractures in children.The advantages of ESIN include primary bone union with avoidance of growth plate injury and minimum invasive surgery.The good results of ESIN are obtained when surgeons have a good knowledge of the principle of the correction of the fracture and its stability, especially in the understanding of the unique pathophysiology characteristics of pediatric fractures.This review discussed the biomechanical mechanisms of ESIN, and the principles,indications and contraindications of ESIN in the treatment of pediatric long bone fractures.The article also comprehensively introduced the application of ESIN in femur,tibia,fibula,humerus, ulna, radius,clavicle and metacarpal bone fractures.The technique details of nailing, preoperative planning, positioning of the patient, sizing of the nail, entry points for the nail, reduction maneuvers for safe passage of nails through the fracture site, and postoperative management were also introduced in this review.
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Objective To summarize the application of elastic stable intramedullary nailing for treating forearm fractures in children and to evaluate its therapeutic effect.Methods A total of 98 cases of forearm fractures in children treated by elastic stable intramedullary nailing were analyzed,retrospectively.Eighty-seven cases were postoperatively followed up,but 11 cases were lost.Fifty-nine cases were male,39 cases were female,ageing from 3 to 16 yearold,and the mean age was 6.5 year-old.Sixty-seven cases were ulnar shaft fracture,23 cases were radial neck fractures and 8 cases were Monteggia fracture.Results Patients were followed up 4 to 36 months.Eighty-seven cases successfully achieved complete healing.Patients recovered with no pain,no deformity and obtained excellent functional recovery.One case achieved delayed healing,and skin irritation was found in 8 cases.Conclusions Elastic stable intramedullary nailing is a minimally invasive,approch easy to deal with soft tissue injury,quick in recovery,and has a good curative effect and fewer complications.Rationally using elastic stable intramedullary nailing for treating forearm fractures in children can achieve satisfactory postoperative outcomes.