title: Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation.
abstract: BACKGROUND
  Short double elastic nailing is a minimal invasive, modified ESIN (elastic stable intramedullary nailing) technique for severely displaced distal radial fracture in children. The aim of this technical report is to introduce our new method and evaluate the final results of the procedure.
  
  
  METHODS
  We reviewed retrospectively 24 patients who underwent short double elastic nailing due to distal radial fractures between November 2012 and December 2015. Indications for surgery included closed, severely displaced, unstable metaphyseal or diametaphyseal fractures of the radius.
  
  
  METHODS
  The fractures were stabilized by 2 prebent short elastic titanium nails inserted from the distal side of the fracture. In cases of associated ulnar fracture, a classic anterograd ESIN nailing was also performed. Patients were mobilized immediately in a removable short splint which was removed after 1 to 2 weeks. There has been no additional splinting or casting.
  
  
  RESULTS
  There were 17 males and 7 females with an average age of 9.8 years (range, 4-16 years). The right hand was involved in 16 cases and the left hand in 8 cases. The average follow-up was 17.8 months (range, 7-28 months). Of the 24 patients, 3 presented irritation of the skin, which resolved after removal of the radial nail. All the patients regained full range of motion without any complications.
  
  
  CONCLUSIONS
  Our technique is an effective, safe, and easily learnable procedure for unstable fractures of the distal third of the radius. It achieves good functional and radiological results, and allows early mobilization without the need of casting. Avoiding the physeal plates, we reduce the risk of iatrogenic postoperative deformity. Further prospective and biomechanical investigations are necessary to verify our experience.
authors.affiliation: Sándor Péterfy Street Hospital and Casualty Centre Surgical Department of Heim Pál Children's Hospital, Budapest Department of Pediatrics, Surgical Unit, University of Pécs, Pécs, Hungary.
authors.forename: Marcell
authors.initials: M
authors.lastname: Varga
authors.forename: Gergő
authors.initials: G
authors.lastname: Józsa
authors.forename: Balázs
authors.initials: B
authors.lastname: Fadgyas
authors.forename: Tamás
authors.initials: T
authors.lastname: Kassai
authors.forename: Antal
authors.initials: A
authors.lastname: Renner
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies