Barry and Paterson review the evolution, biomechanical principles, and bone-specific applications of elastic stable intramedullary nailing (ESIN) in pediatric long bone fractures, from historical forerunners through the Nancy technique, with practical guidance on indications and technique for each anatomic region.
When a child aged 5–14 presents with a diaphyseal femur or forearm fracture requiring operative fixation, ESIN with two pre-bent titanium nails (each 2/5 of canal diameter) is the standard approach — but recognize that rotational instability is its inherent limitation, and in older or heavier children consider supplemental cast bracing.
For forearm fixation specifically, K-wires are an equally valid alternative to elastic nails and should remain in your toolkit.
Barry and Paterson review the evolution, biomechanical principles, and bone-specific applications of elastic stable intramedullary nailing (ESIN) in pediatric long bone fractures, from historical forerunners through the Nancy technique, with practical guidance on indications and technique for each anatomic region.
When a child aged 5–14 presents with a diaphyseal femur or forearm fracture requiring operative fixation, ESIN with two pre-bent titanium nails (each 2/5 of canal diameter) is the standard approach — but recognize that rotational instability is its inherent limitation, and in older or heavier children consider supplemental cast bracing.
For forearm fixation specifically, K-wires are an equally valid alternative to elastic nails and should remain in your toolkit.