Complications of Elastic Stable Intramedullary Nailing in Pediatric Fracture Management by Shital N. Parikh, Viral V. Jain, Jaime Denning, Junichi Tamai,

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Presentation transcript:

Complications of Elastic Stable Intramedullary Nailing in Pediatric Fracture Management by Shital N. Parikh, Viral V. Jain, Jaime Denning, Junichi Tamai, Charles T. Mehlman, James J. McCarthy, Eric J. Wall, and Alvin H. Crawford J Bone Joint Surg Am Volume 94(24):e184 December 19, 2012 ©2012 by The Journal of Bone and Joint Surgery, Inc.

A distal femoral metaphyseal fracture can be stabilized by antegrade ESIN (elastic stable intramedullary nailing). Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-A Nail prominence (white arrow) is the most frequent complication with ESIN (elastic stable intramedullary nailing). Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A One week after ESIN (elastic stable intramedullary nailing), this eight-year-old girl had a fall. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A and 4-B Varus (Fig. 4-A) and procurvatum (Fig. 4-B) are the most common malunion deformities after femoral ESIN (elastic stable intramedullary nailing). Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-A A twelve-year-old boy weighing 35 kg sustained a comminuted femoral fracture during wrestling. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A A dorsal-entry nail used to treat a distal radial metaphyseal fracture is routinely cut flush (black arrow). Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-A A twelve-year-old boy sustained a comminuted tibial fracture in a dirt-bike accident. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

The radial nail became incarcerated in the diaphysis, and forceful retrograde impaction for entry into the proximal fragment caused physeal distraction (black arrow) and subsequently physeal closure. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Four years after ESIN (elastic stable intramedullary nailing), the radial nail migrated proximally, and a stress fracture occurred at the tip of the nail. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 10-A An attempt was made to treat the distal femoral fracture in an eleven-year-old girl with a combination of a retrograde medial nail and an antegrade lateral nail. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Inadequate nail contouring or forceful entry of the nail can cause cortical perforation (black arrow in Fig. 11-B). Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.

The importance of orthogonal fluoroscopic views cannot be overemphasized. Shital N. Parikh et al. J Bone Joint Surg Am 2012;94:e184 ©2012 by The Journal of Bone and Joint Surgery, Inc.