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Thoughts on the Principles of Elastic Stable Intramedullary Nailing (ESIN)

On 12/11/2018
Article viewed 87 times

Thoughts on the Principles of Elastic Stable Intramedullary Nailing (ESIN)

By J.D. METAIZEAU, Delphy DENIS in category TECHNIQUE
Service de Chirurgie Orthopédique Infantile CHU Dijon

For over 40 years, elastic stable intramedullary nailing (ESIN) has been regularly used to treat fractures of the long bones in children.
Although the technique has been widely described, experience shows that the precise principles are often poorly understood. Therefore, we provide a recap here, without looking at the operative technique in detail.

 

For over 40 years, elastic stable intramedullary nailing (ESIN) has been regularly used to treat fractures of the long bones in children.

Although the technique has been widely described, experience shows that the precise principles are often poorly understood. Therefore, we provide a recap here, without looking at the operative technique in detail. 

 

Theory

Elastic stable intramedullary nailing (ESIN) is often taught as a bipolar assembly. This is true in theory, ‘in vitro’ – on an orthopaedic model, for example: that is, a single bone. In such cases, if it is sectioned and a perfect assembly is desired, the two pins must be opposed (Fig. 1).

Figure 1 : With a single bone, the two pins must be opposed for perfect balance.

 

In practice, however, tension is exerted on the bone via different muscles. Additionally, the trauma will have produced soft tissue lesions as well as the fracture in question, thus generating deforming forces; some of these will be negative and some positive, but an overall deforming force will be the result. This will have different components to varying degrees: shortening, rotation, translation, varus or valgus, and flexum or recurvatum.

Let us consider a typical case of a transverse diaphyseal femur fracture. Obviously, the first stage will be to...

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