Andrew Howard, James Hunter, Theddy Slongo
One great advantage of the ESIN for proximal femoral fractures is that the approach is minimally invasive of the soft tissues, facilitating early joint motion.
Entry points for the medial and first lateral nails are 2 cm above the physis.
If a third nail is needed, a second lateral entry point is marked 1.5 cm proximal to the first lateral entry point.
An incision starts at each planned entry point and extends 2-4 cm distally depending on the size of the child.
The subcutaneous tissues are divided by blunt dissection until the lateral and medial cortices of the femur are reached.
Subcutaneous and skin closure according to the surgeon's preference.