title: [Elastic Stable Intramedullary Nailing (ESIN) of Metatarsal Fractures].
abstract: OBJECTIVE
  In the treatment of metatarsal fractures, the objective is early restoration of the physiological painless function of the foot. While undisplaced metatarsal fractures can be treated non-surgically, displaced fractures are a valid indication for reduction and internal fixation. Whereas plate fixation may lead to soft tissue irritation involving tendon adhesions and scar formation, retrograde percutaneous pinning may harm the intact metatarsophalangeal joint and lead to joint stiffness. We have therefore used the technique of elastic stable intramedullary nailing (ESIN) with titanium elastic nails (TEN) to achieve minimally invasive, antegrade splinting of short metatarsal shaft and neck fractures.
  
  
  METHODS
  Within 7 years, ESIN was performed in 22 patients. The surgical technique is presented and the functional results and complications were retrospectively evaluated using the AOFAS Midfoot Score.
  
  
  RESULTS
  Nineteen patients were analysed after an average follow-up of 25.6 ± 21.3 months (range: 3-72 months). The mean AOFAS score was 93.9 ± 10.4 (range 62-100) points. One case of skin irritation required TEN shortening. Pseudarthrosis, secondary fracture dislocation and nail breakage were not observed. After TEN removal 13.4 ± 12.9 (range: 5-52) weeks after implantation, no refracture occurred.
  
  
  CONCLUSIONS
  Antegrade, minimally invasive, elastic stable intramedullary nailing of short metatarsal shaft and neck fractures using titanium nails (TEN) is a safe surgical procedure and achieves primary functional stability. It reliably leads to fracture healing and produces good functional results.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn.
authors.forename: M
authors.initials: M
authors.lastname: Hettchen
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn.
authors.forename: A C
authors.initials: AC
authors.lastname: Strauss
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn.
authors.forename: P H
authors.initials: PH
authors.lastname: Pennekamp
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn.
authors.forename: C
authors.initials: C
authors.lastname: Burger
authors.affiliation: Chirurgische Klinik, St. Josefs Hospital Lennestadt.
authors.forename: O
authors.initials: O
authors.lastname: Weber
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn.
authors.forename: M C
authors.initials: MC
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D002648:Child; D055119:Elastic Modulus; D005260:Female; D018409:Foot Injuries / Q000175:diagnosis / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D011474:Prosthesis Design; D016896:Treatment Outcome; D055815:Young Adult