Introduction ESIN is an established method of treatment of long bone fractures in children, which has been in regular use in our institution since 1996. We report on our 7-year experience of using ESIN for the treatment of long bone fractures in children.

Method 92 fractures were nailed (26 femoral, 12 tibial, 17 humeral and 37 forearm). The average age was 12 years (7–15) and average follow-up 15 months. Main indications included unstable and severely displaced fractures, failure of conservative treatment and polytrauma or head injury. Data collection included mechanism of injury, fracture configuration, treatment delay, operation time and technique, length of hospital stay, rehabilitation, healing, nail removal and complications.

Results 49% of fractures were caused by road traffic accidents. All were diaphyseal apart from 14 proximal humeral fractures. The average surgery delay was 7 days and operation time 78 minutes. Open reduction was performed in 3 femoral, 1 humeral and 18 forearm fractures. Single nailing was used for the proximal humeral and forearm fracture. The average hospital stay was 5.8 days, ranging from 12 days for femoral to 2 days for forearm fractures. Clinical healing was achieved at 3.5, 4.3, 2.4 and 2.1 months respectively for femoral, tibial, humeral and forearm fractures.

The commonest complication (25%) was skiin irritation around the entry site, which invariably resolved after implant removal. Delayed union occurred in 2 femoral and 2 tibial fractures (all healed following bone marrow injection). 2 tibial fractures mal-united and 1 tibial fracture was complicated with compartment syndrome. The average nail removal time was 9 months. The nails could not be removed in 4 cases.

Conclusion ESIN is minimally invasive and has a low complication rate. It avoids the lengthy immobilization of conservative treatment, and the surgical trauma of plating without the association of refractures or nerve damage. We believe it represents a valid option in the treatment of long bone fractures.

Aim: To report on the bone histology of patients undergoing intramedullary stabilisation for a pathological fracture or a metastatic lesion in long bones.

Materials and methods: From 1999 to 2002, 36 long bones in 29 patients (seven had stabilisation of two long bones) were stabilised with an intramedullary nail in patients with a known primary tumour. Prophylactic fixation was performed in 19 bones with metastatic tumour and in 17 for a fracture. Of the 17 fractures, 13 were considered pathological and four were simple fracture unrelated to metastasis. Thirty-three nailings were done for proximal femoral lesions and three were for the humerus. Reaming samples were sent for histological analysis. The various sites of the primary tumour were Breast (13), Myeloma (6), Prostate (5), Lung (4), Unknown (3), Bladder (2), Oesophagus (1), Renal (1), Melanoma (1). The histological results were correlated with the clinical diagnosis.

Results: Thirty-six reaming samples were sent for histological analysis. Twenty-two samples correlated with the clinical diagnosis. Of the 22 tissue samples, two did not have a initial confirmed histological diagnosis of primary and the reaming samples helped to achieve this. Fourteen biopsies gave false negative results.

Conclusion: Approximately two-thirds of the time the reaming sample has correlated with clinical diagnosis. Sensitivity of this test is 61%.