We report the use of elastic stable intramedullary naffing (ESIN) in 123 fractures of the femoral shaft in children. Flexible rods are introduced through the distal metaphyseal area, and the aim is to develop bridging callus. Early weight-bearing is possible and is recommended. There was one case of bone infection and no delayed union. Complications were minimal, the most common being minor skin ulceration caused by the ends of the rods. A surprising feature was the low incidence of growth changes, with a mean lengthening of only 1.2 mm after an average follow-up of 22 months. Compared with conservative treatment, ESIN obviates the need for prolonged bed rest and is thus particularly advantageous for treating children.

Stable intramedullary pinning is an excellent method for treating shaft fractures in children when there is an indication for operative management. It is a new biomechanical concept which aims at developing the bridging external callus. This closed pinning uses flexible rods which are introduced into a metaphysial area. Technique, results and indications are described particularly in regard to shaft fractures of the femur and the forearm. This closed surgical procedure can always be performed; complication rates are slight (no sepsis, no delayed union). Early mobilisation is possible, and use of a cast is unnecessary.

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Travail pr6sent6 au Sdminaire d'Enseignement -Actualit6s en Orthop6die Pddiatrique, organis6 du 19 au 21 mars 1992 ~t 68150 Aubure par le Docteur Claude Karger consolidation of the fracture seat. The technique consisting in the placing under closed seat of centro-medullar pins propped up and bent can be adapted to almost all diaphyseal and metaphyseal fractures of the child.

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