title: Complications of ESIN osteosynthesis--Experience in 270 patients.
abstract: BACKGROUND
  Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications.
  
  
  METHODS
  A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years.
  
  
  RESULTS
  A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1cm.
  
  
  CONCLUSIONS
  Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
authors.affiliation: Department of Paediatric Surgery, University Hospital Rijeka, Rijeka, Croatia. Electronic address: nado.bukvic@optinet.hr.
authors.forename: Nado
authors.initials: N
authors.lastname: Bukvić
authors.affiliation: Department of Surgery, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Marin
authors.initials: M
authors.lastname: Marinović
authors.affiliation: Department of Surgery, General Hospital Karlovac, Karlovac, Croatia.
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
authors.affiliation: Department of Paediatric Surgery, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Ana Bosak
authors.initials: AB
authors.lastname: Veršić
authors.affiliation: Department of Paediatric Surgery, General Hospital Zadar, Zadar, Croatia.
authors.forename: Robert
authors.initials: R
authors.lastname: Karlo
authors.affiliation: Department of Paediatric Surgery, Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.
authors.forename: Ante
authors.initials: A
authors.lastname: Kvesić
authors.affiliation: Department of Surgery, General Hospital Pula, Pula, Croatia.
authors.forename: Nadomir
authors.initials: N
authors.lastname: Gusić
authors.affiliation: Institute for Anthropological Research, Zagreb, Croatia.
authors.forename: Miran
authors.initials: M
authors.lastname: Čoklo
authors.affiliation: School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Frane
authors.initials: F
authors.lastname: Bukvić
mesh_terms: D000293:Adolescent; D001134:Arm Injuries; D002648:Child; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005264:Femoral Fractures / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000473:pathology / Q000601:surgery*; D007869:Leg Injuries; D008297:Male; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Children; Complication; ESIN osteosynthesis