title: Quadruple ESIN (Elastic Stable Intramedullary Nailing): Modified Treatment in Pediatric Distal Tibial Fractures.
abstract: OBJECTIVE
  Nailing of the tibial shaft with 2 Prevot nails is the gold standard for tibial shaft fractures in children. This technical report aims to show a simple way to stabilize pediatric distal tibial fractures without changing of the operation method.
  
  
  METHODS
  A retrospective chart review of all distal tibial fractures treated with the modified elastic stable intramedullary nailing (ESIN) method during a 6-year period was conducted. The modified ESIN technique hardly differs from the classic method, other than the addition of 2 other Prevot nails inserted using the same entry point.
  
  
  RESULTS
  Eight children were treated with the modified ESIN. The mean operation duration was 57 minutes (range, 33 to 88 min). In all cases 2 to 4 mm titanium nails were used. None of our patients required a postoperative cast.Within an average of 14.5 days all of the patients could fully bear their weight (2 to 30 d) and full range of motion was reached.
  
  
  CONCLUSIONS
  The modified ESIN technique achieves good results regarding stability and early weight-bearing. Therefore, this technique could be applied in unstable distal tibial fractures. Nevertheless, a prospective and biomechanical study is needed to verify our experience.
  
  
  METHODS
  Level IV-therapeutic studies.
authors.affiliation: Department of Pediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Jan
authors.initials: J
authors.lastname: Bauer
authors.forename: Corinna
authors.initials: C
authors.lastname: Hirzinger
authors.forename: Roman
authors.initials: R
authors.lastname: Metzger
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002662:Child Health Services; D005260:Female; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome