RT Journal
A1 Parikh, Shital N.
A1 Jain, Viral V.
A1 Denning, Jaime
A1 Tamai, Junichi
A1 Mehlman, Charles T.
A1 McCarthy, James J.
A1 Wall, Eric J.
A1 Crawford, Alvin H.
T1 Complications of Elastic Stable Intramedullary Nailing in Pediatric Fracture ManagementAAOS Exhibit Selection
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2012
FD December 19
VO 94
IS 24
SP e184 1
OP 14
DO 10.2106/JBJS.L.00668
UL http://dx.doi.org/10.2106/JBJS.L.00668
AB 
Elastic stable intramedullary nailing (ESIN) for pediatric fracture management has gained increasing popularity since its introduction in the late 1970s. Relatively few modifications have been made to the original technique in the last forty years, which illustrates the sound biomechanical principles and simplicity of the technique. Jean-Paul Metaizeau, the originator of the technique, pointed out that poor results after ESIN were typically due to incorrect constructs, incorrect indications, and insufficient surgeon training1. The initial (1977 to 1980) indications for ESIN were limited to pediatric patients with multiple injuries or head trauma in whom cast or traction treatment was not practical. Later, its use was extended to all diaphyseal fractures of long bones in children. With widespread acceptance, the indications have been further expanded to metaphyseal fractures, comminuted fractures, pathologic fractures, and fractures of smaller bones (including clavicular, supracondylar humeral, and metacarpal fractures). ESIN was introduced in the United States in 19972. The literature is replete with reports of the clinical success of ESIN, but reports related to its complications are scarce. The aim of this manuscript was to review the common complications related to ESIN and provide technical pearls to manage and avoid complications.