Elastic stable intramedullary nailing (ESIN) with TEN (Titanic elastic nail) or STEN

Introduction

Elastic stable intramedullary nailing (ESIN, TEN, Prévot nailing) is a possibility of surgical treatment of various bone fractures. This method is particularly suitable for the treatment of childhood fractures of the long tubular bones, such as the upper arm, forearm, thigh and lower leg. The technique involves inserting flexible titanium (TEN) or steel (STEN) nails into the fractured bone.

The nails are flat and angled at their tips. A special technique is used to insert the nails into the bone, causing them to clamp each other within the bone, thus creating a stable connection between the two bone fragments. This technique is particularly suitable for children, since the growth joints, which are extremely important for bone growth, are spared in ESIN. Bone growth is therefore not negatively affected when performing an ESIN. Likewise, the affected bone can be loaded again after a short time and no plaster cast is necessary in the post-treatment.

Indications

Nowadays, ESIN is mainly used for fractures in children. Especially for fractures of the long tubular bones, ESIN is a popular therapy method. Fractures of the upper and lower arm as well as of the femur or lower leg are therefore popular indications for ESIN.

It should be noted that in many cases, bone fractures can be treated with conservative therapy and only when the bone fragments are severely dislocated can surgical therapy be considered. The reason why especially fractures in children are treated with ESIN is that nailing is used to protect the important growth joints of the children and thus the bone growth is not negatively influenced by the therapy. Recently, collarbone fractures have also been treated with ESIN.

Not all types of bone fractures are suitable for ESIN. For example, nailing should not be used if a fracture involving the joint is present. Care should also be taken to ensure that the affected child is suitable for nailing.

For example, it has been found that nailing of fractures of the upper or lower leg is not sufficiently stable in overweight children, so this technique cannot be recommended in this case. The forearm is made up of two different bones: the radius (medical term: radius) and the ulna (medical term: ulna). Both bones belong to the tubular bones and are in principle suitable for performing elastically stable intramedullary nailing.

The fracture of the radius is one of the most common fractures in humans. In order not to endanger the growth of the fractured bone, the therapy of a fracture of the forearm is attempted in children using ESIN. The advantage of treating a fracture of the forearm with ESIN is that it is not necessary to put a cast on the forearm and it is possible to put a load on the forearm early on.

ESIN is recommended for children with forearm fractures if the fractures are displaced and are not accompanied by significant injuries to the soft tissue. The humerus is one of the long tubular bones of the human skeleton. Only rarely is the humerus affected by fractures.

Fractures of the humerus in children are surgically treated using the ESIN when the bone fragments are in a certain defective position. The advantages of the ESIN are particularly evident when the fracture of the humerus is close to the elbow. Important nerves that run at the site of the fractured humerus are spared with the ESIN technique and there are fewer complications after the operation.

Likewise, the affected arm can be loaded again promptly after the operation without the need for a plaster cast. Removal of the nails is only recommended at a later stage with a local anesthetic. The femur is the largest bone of the human skeleton.

Nevertheless, it can lead to a fracture of the bone, which often requires surgical treatment. The type of fractures as well as their treatment differ between children and adults. ESIN is often the treatment of choice for children older than 3 years of age who have suffered a fracture of the femur.Since nailing partially lengthens each affected leg, and since this can cause a number of different problems, it is important to consider using nailing before the age of ten.

The main advantage of ESIN is that the affected children can put weight on the treated leg again early after the operation, thus avoiding malpositioning and complications of prolonged immobilization. In cases where there is severe instability of the bone fragments or significant soft tissue damage, external fixation of the bone fragments (external fixator) can be used in addition to the ESIN. The clavicle is the bony connection between the shoulder blade on one side and the sternum on the other side and plays an important role in movements in the shoulder joint.

Since it is a relatively fragile and exposed bone, clavicle fractures are not uncommon. One possibility to treat a collarbone fracture is to use the elastically stable intramedullary nailing. Thus, clavicle fractures have recently become one of the main indications for performing this technique.

In contrast to the other indications, ESIN is also frequently used in adults with a collarbone fracture. This is the case when the collarbone is broken in its center, the bone shaft. Only then can sufficient stability be achieved by nailing.

However, it is not always necessary to surgically treat a collarbone fracture. In many cases, a conservative therapy can achieve the desired treatment success without the risk of possible complications. Therefore, the exact indication and experience of the treating physician is important for the success of the therapy.