Abstract
Shaft fractures of the long bones are among the most common pediatric injuries. They
are characterized by a limited potential for spontaneous correction because of the
fractures—distance to the physis. Although conservative treatment has been practiced
for many years with satisfying results, several aspects have led to an increase in
the numbers of surgical procedures including changes of living, sports habits, economics,
and patients—request to treatment. We reviewed the literature to describe developments
of treatment concepts of pediatric shaft fractures. In shaft fractures of the upper
extremities, increasing rates of surgical procedures have been reported preventing
functional deficits of forearm prosupination and cosmetic deformities of the humerus.
In fractures of the lower extremities maximizing stability shifted into the focus
of interest to achieve early mobilization and to compensate heavier body weights of
children and adolescents. Consecutively, the current gold standard of pediatric shaft
fracture treatment—ESIN (elastic stable intramedullary nailing)—has been modified
repeatedly using end caps, prebended nails, and optimized surgical techniques. In
addition, new methods such as rigid locking nails and plates have been included in
the treatment approaches for femur and tibia shaft fractures. All these methods of
pediatric fracture care carry inherent advantages that require consideration for each
clinical situation. On the other side, this has enlarged the spectrum of potential
complications, which needs continuous evaluation to further improve treatment results.
Keywords
pediatric trauma - shaft fractures - elastic stable intramedullary nailing - complications
- long bones
