Authors of section


Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

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ESIN entry points in the pediatric femur for retrograde nailing

1. General considerations

For fracture patterns stabilized with the ESIN technique using a retrograde approach and two elastic nails, the entry points are at the same level in the distal femur on the lateral and medial side.

The entry points are 2–3 cm proximal to the growth plate, in the middle of the femoral shaft in the sagittal plane.

Position of nail entry points

2. Skin incision

Make a 3 cm skin incision starting at the entry point and extending distally. This allows sufficient space to advance the nails at an angle to the cortex.

Skin incision

3. Deep dissection

Spread the fascia and muscle to expose the cortex of the femur.

Exposure of the cortex of the femur

4. Wound closure

After careful hemostasis, close the skin and subcutaneous tissues in a routine manner, preferably with resorbable sutures.

Wound closure
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