Abstract
Aim
The purpose of this study was to quantify the number of children treated with ESIN (elastic stable intra-medullary nails) at our institution and to determine what proportion of these nails have been removed and the time and difficulty taken to do so.
Methods
Patients treated with ESIN between 2000 and 2005 were identified by database search. Their notes were reviewed to record patient and initial nailing details, and timing, difficulty and length of metalwork removal procedures. Complications leading to premature removal or following nail extraction were noted.
Results
Eighty-seven patients were identified who fitted our study criteria (68% male, 32% female). Mean age was 10.9 years (4.7–15.9 years). Twelve of the procedures were for open fractures. Seventy-nine patients underwent nail removal at our institution. Four were followed up elsewhere and a decision to leave the nails in was made in another four patients (usually underlying bone pathology). Four patients had surgery earlier than planned to deal with implant problems: 3 to address prominent nails and 1 for re-fracture. The nails were removed at a mean of 8 months after insertion. Mean time taken to remove the metalwork was 25 minutes (10 to 75 minutes). Eight of the 79 removal procedures were graded as difficult, with one being extremely difficult: this was not predictable from pre-operative radiographs. There were 2 complications following metalwork removal. One was a re-fracture through a unicortical bone cyst 2 years after removal, which was successfully treated with ESIN again. The other was a superficial wound infection, which settled with antibiotics.
Conclusion
It is routine policy at our institution to remove ESIN after fracture healing, but it should be noted that removal procedures can be difficult and lengthy. There is, however, a low complication rate following removal, and routine follow-up may not be necessary.
