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Trauma: K. R. Prathapkumar, N. K. Garg, and C. E. Bruce Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children J Bone Joint Surg Br 2006; 88-B: 358-361 [Abstract] [Full text] [PDF]

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Elastic stable intramedullary nail fixation

Shashank D Chitgopkar   (12 April 2006)

Elastic stable intramedullary nail fixation 12 April 2006
Shashank D Chitgopkar, Senior House Officer Harrogate district hospital, Harrogate, North Yorkshire, United Kingdom Send letter to journal: Re: Elastic stable intramedullary nail fixation shashankdc{at}hotmail.com Shashank D Chitgopkar	Sir, I read this article with great interest. The authors have achieved an excellent functional outcome in 13 of their 14 patients, and a good functional outcome in the remaining one. This would mean that the functional outcome of the 11-year-old girl, who developed asymptomatic avascular necrosis of the radial head, is either excellent or good. Is it because she had this injury just three years before fusion of the radial head epiphysis? Would her long-term follow-up change the functional outcome? It is recommended to pre-bend the wire in a gentle curve1,2 of 20 degrees to obtain a three-point fixation. For a three-point fixation, the apex of the bend should be at the level of the fracture.3 But is it necessary to pre-bend wires for intramedullary pinning of children’s fractures? In fact, in treating shaft fractures in children it may not be necessary to pre-bend the wires.4-6 I agree with Slongo and Zachariou3 that in Elastic Stable Intramedullary Nailing (ESIN), the nail is primarily a tool and it only functions secondarily as an implant. This unique situation is very well-applied in treating radial neck fractures. And it would probably be appropriate to label this procedure as centromedullary pinning,1 or Closed Intramedullary Pinning (CIMP).2 Interestingly, Havranek and Pesl7 have divided the children’s fractures they treated with ESIN into three groups. Radial neck fractures fall into the second group of a non-typical ESIN procedure. Prof. JP Metaizeau classifies most radial neck fractures in children as metaphyseal. His experience of using a wire with a sharp tip agrees with that of the authors.8 He suggested a new classification of radial neck fractures in children which works as an algorithm for their treatment. S.D. Chitgopkar, Senior House Officer, Harrogate District Hospital, N. Yorks, UK. 1. Metaizeau JP. Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning. Injury. 2005;36:SA75—77. 2. Metaizeau JP, Lascombes P, Lemelle JL, Finlayson D, Prevot J. Reduction and fixation of displaced radial neck fractures by Closed Intramedullary Pinning. J Pediatr Orthop. 1993;13:355-360. 3. Slongo TF, Zachariou Z. Treatment of femoral shaft fractures in children. AO dialogue. 2005;18:II. 4. Chitgopkar SD. Internal fixation of femoral shaft fractures in children by intramedullary Kirschner wires (a prospective study): its significance for developing countries. BMC Surg 2005 29;5:6. http://www.biomedcentral.com/1471-2482/5/6 5. Qidwai SA, Khattak ZL. Treatment of femoral shaft fractures in children by intramedullary Kirschner wires. J Trauma 2000;48:256-9. 6. Kiely N. Mechanical properties of different combinations of flexible nails in a model of a pediatric femoral fracture. J Paediatr Orthop 2002;22:424–7. 7. Havranek P, Pesl T. Use of the elastic stable intramedullary nailing technique in non-typical pediatric fractures. Acta Chir Orthop Traumatol Cech. 2002;69:73-8. Czech. 8. Metaizeau JP. Instructional course lectures. European Research and Educational Meeting in Paediatric Orthopaedics (EREMPO), Marseilles, France. October 2004.