Biomechanical Performance of BoneHelix® Compared with Elastic Stable Intramedullary Nailing (ESIN) in a Pediatric Tibia Fracture Model

Tibial shaft fractures are common injuries in the pediatric and adolescent populations. Elastic stable intramedullary nailing (ESIN) is the treatment of choice for cases that require surgical stabilization. A new intramedullary device, BoneHelix® (BH), may be an alternative for use with fractures that cannot be satisfactorily stabilized with ESIN. This study aimed to assess the biomechanical performance of BH compared with ESIN in a porcine tibia fracture model, observing cyclic fatigue and load to failure. Computed tomography was used to monitor the implant position and to rule out unintended damage. No implant or bone failure occurred during the fatigue testing. An increase in the cumulative plastic displacement was observed in both test groups over the loading cycles applied. Both implant–bone constructs displayed a trend toward closure of the osteotomy gap. During the load-to-failure test, the average loads at failure in specimens instrumented with ESIN and BH were 5364 N (±723) and 4350 N (±893), respectively, which were not statistically significant (p = 0.11). The values of both groups were two to three times higher than the estimated maximal load (2000 N) during physiological weight bearing. The biomechanical results thus indicate equivalent performance and stability by the implants tested.

The advent of elastic stable intramedullary nailing for the treatment of long bone fractures in skeletally immature patients

Introduction Management of pediatric long bones fractures is a complex and rapidly evolving field. Traditionally, casting and conservative techniques played a key-role in the management of fractures in skeletally immature patients. However, the surgical approach has evolved steadily over the past four decades or so and increasing evidence has been published supporting the advantages of fixation techniques over conservative methods. The purpose of this narrative review is to outline how innovations in orthopedic surgery have changed the rationale of treating long bones fractures in children and adolescents with focus on surgical techniques, particularly elastic stable intramedullary nailing (ESIN). Material and methods We aimed to describe the main trends in pediatric long bones fractures management and to identify its specificities and difficulties as well as the best standard of care. Results The introduction of ESIN has profoundly influenced the management of pediatric upper and lower extremity fractures. Overall, in comparison to conservative techniques, advantages of ESIN include minimally invasiveness, short hospital stay, primary bone union, early mobilization and progressive weight bearing, and good outcome with low complication rate. Moreover, the flexible nail can be used as a closed reduction tool itself. Conclusions Irrespective of the technique performed, the key-concepts remain 1) the proper understanding of the injury to treat; 2) the identification the main characteristics of the patient; 3) the pros and cons of each technique; and 4) the potential complications.

Clinical Outcome of Percutaneous Intramedullary Fixation for Midshaft Clavicular Fractures Using Elastic Stable Nails

Background. This study investigated the clinical outcomes of fixation of displaced middle-third clavicular fractures using percutaneous elastic stable intramedullary nails. Material and methods. This study included sixty patients with a mean age of 26.40 ± 8.91 years (16-53 years) presented with a displaced middle third fracture of the clavicle. According to the Robinson classification, 48 cases (80%) were type 2B1, 9 cases (15%) type 2B2 and 3 case (5%) 2A1. All cases were treated by elastic intramedullary nails and followed up for at least 12 months. Results. At the end of the twelve months’ follow-up period, the mean Constant Shoulder score was 95.70 ± 13.55, ranging from 48 to 100. 54 patients (90%) had excellent results, 3 patients (5%) had an adequate result and 3 patients (5%) had a poor result. There was a statistically significant relationship between the final score and age and associated medical conditions. Conclusions. 1. Elastic Stable Intramedullary Nailing is an image-dependent procedure indicated best for young medically free athletes with simple 2-part middle third clavicle fracture. 2. Hammering is not recommended to avoid dorsolateral cortex perforation. 3. The most common complication is medial skin irritation because of the subcutaneous position of the clavicle as well as the sharp end of the cut nail.