The document details a surgical technique using elastic nails for treating shaft fractures in children aged 4 to 12-13 years. It emphasizes the importance of nail diameter, pre-contouring, and precise alignment during insertion to optimize stability and holds technical specifications for various bone sites including the femur, tibia, and humerus. Additionally, it addresses the surgical approach and angles necessary for effective nailing in pediatric fractures.

1. TENS

2. ESIN-retrograde
*Shaft fractures of the middle and proximal third in children
*From 4 up to 12–13 years of age (depending on body size/weight)
ESIN - anterograde- D/3rd
*Symmetrical bracing action two elastic nails inserted into metaphysis
Principle - flexural, axial, rotational and translation stability
3 point contact construct

3. Technique
*For optimal stability, the nail diameter -b/w 33% and 40% of the narrowest part
(isthmus) of the medullary canal.
*Both nails need to be of the same diameter

4. *Precontour both nails with the apex
at the level of the fracture site.
* nail bend should be about three times
the diameter of the medullary canal.

7. Reduction
*F tool
*P/c stienmen pin
*Bone hook
*Open reduction

8. Final seating
* level of the lesser trochanter.
*Impact the nail started on the lateral side towards the greater trochanter.
*Optimally the nail tips are at the same level.
*Align the nail tips so that they diverge.
*Proximal 3rd-advance the medial nail into the femoral neck and the lateral nail
into the greater trochanter.

10. Anterograde esin
Entry point

11. S shaped inferior nail
*Once it has good contact with the opposite cortex, with the tip having advanced
about two-thirds distally in the medullary canal.
1.Rotate the nail 180°.
2.Bend the proximal portion of the nail, which is outside the bone, in the opposite
direction to the previous bend.
3.Apply a constant bending force whilst inserting the nail.

13. Other sites -2. tibia shaft
*When the medullary canal is entered, angle
the drill or awl handle 60° to the shaft axis.
* Less steep than in elastic nailing of
other long bones, as the medullary canal of
the proximal tibia has a wide trapezoidal-
shaped medullary canal.

14. 3.proximal humerus

15. 4.S/c humerus
● The first entry point is on the lateral
aspect of the humerus, just below
the insertion of the deltoid muscle.
● If the deltoid insertion is not palpable
, the entry point must be at least
4-5 cm (depending on the size of the
child) distal to the proximal growth
plate. Mark this entry point on the
skin.
● The second entry point is 2 cm distal
and 1 cm anterior to the first entry point oin

17. 5.radial head#(metaizeau technique)

18. 6.montegia

19. 7montegia equivalent

20. 8.#bbfa
*Nail diameter :60-70% of medullary canal
D/1- bowing,D/2-green stick#, D/4& D/5- complete #

22. Thank you