![Elastic nails - Synonyms
• Elastic stable intra medullary
nail[ESIN]
• Titanium Elastic Nails[TEN]
• Titanium Elastic Nail System[TENS]
• Metaizeau nail
• Nancy Nail](https://image.slidesharecdn.com/9-250803055325-4ddc19f8/85/Titanium-elastic-nailing-system-overview-6-320.jpg)
Titanium elastic nailing system overview
- 1. Nailing in Paediatric Patients: Elastic Nails and Beyond Dr. Suhas S Shetty Final year post graduate resident Prof B.P. Sir unit IOT ,MMC Chennai
- 2. Why Nailing in Paediatrics? Minimally invasive Preserves periosteum and growth plates Allows early mobilization Lower risk of infection and nonunion High patient and parent satisfaction
- 3. History of Elastic Titanium Elastic Nailing System (TENS)– A Revolution in Pediatric Orthopedic Trauma – Pioneering Work: Dr. Andrew M. Pankovich (1970s)Introduced flexible intramedullary nailing using stainless steel nails/wires. Focused on pediatric forearm fractures Concept: Elasticity helps reduce and stabilize fractures while preserving growth.
- 4. Modern Breakthrough: Dr. Jean-Pierre Métaizeau -Developed and standardized the Titanium Elastic Nailing System (TENS). Used prebent titanium nails for Elastic Stable Intramedullary Nailing (ESIN). Allowed:Minimally invasive fixation Elastic recoil and three-point fixation Avoidance of open reduction
- 5. Dr. Métaizeau - Minimally invasive flexible nailing specifically for pediatric long bone fractures. Used prebent titanium elastic nails that allowing stability, early mobilization, and avoiding open reduction. His technique particularly revolutionized treatment for radial neck fractures in children, where open surgery often led to complications like stiffness or growth arrest.
- 6. Elastic nails - Synonyms • Elastic stable intra medullary nail[ESIN] • Titanium Elastic Nails[TEN] • Titanium Elastic Nail System[TENS] • Metaizeau nail • Nancy Nail
- 7. Main characteristics of Tens nailing Minimally invasive Minimally traumatic More biological Pre-countered to provide some elastic properties Provides sufficient stability Allows early movement and partial weight-bearing.
- 8. BIOMECHANICS •Three-Point Support Mechanism : Each flexible nail contacts the inner cortex of the bone at three distinct points, creating an opposing elastic force that stabilizes the fracture. •This tri-planar contact neutralizes deforming forces, including axial compression, bending, torsion, and translation.
- 9. Balanced Elasticity :The elastic deformation of the pre-bent nails ensures sustained pressure against the inner cortical walls This internal tension resists fracture displacement while allowing micromotion, which stimulates callus formation and enhances biological healing.
- 10. Axial, Rotational, and Translational Stability : As seen in the image, when an axial force (F) acts on the limb, the nail resists translation and rotation through counteractive bending forces (vectors R, S, and C). The curved nails form a closed loop system that absorbs and redistributes stresses effectively, thus preventing collapse or malrotation
- 11. • Superiority Over K-Wires : Unlike K-wires, which only offer point fixation, TENS nails provide a more extensive internal contact area, offering better resistance to rotational and axial loads. • Preservation of Growth Plates: TENS is particularly suited for the pediatric population because it avoids the physis (growth plate), minimizing the risk of growth disturbances.
- 12. Principles of application Precontour • To achieve three-point fixation from inside • Tension within the nail provides a "memory efect"
- 13. Degree of curvature: • 3x the diameter of bone
- 14. Apex of curvature: • At level of fracture
- 15. Two nails: • Same diameter
- 16. Two nails: • Same diameter • ldentically precontoured • Opposite each other • Identical entry points
- 17. • Same diameter • ldentically precontoured • Opposite each other • ldentical entry points Balanced construct
- 18. BIOMECHANICS Number of nails: • Two nails in most cases (femur, tibia, humerus) • Same diameter • Identically precontoured • Balanced construct • Opposite each other
- 19. • One nail: (forearm) • Three nails Special: (proximal femur, pathological)
- 20. Type of configuration • Both-side insertion (usual) • ldentical, symmetrical
- 21. Single-side insertion • Distal/proximal humerus, distal femur • Special S-shape configuration
- 22. Indications for elastic nails • Children aged 3-15 years • Less than 45-50 kg (100-110 Ibs) • Diaphyseal fractures of long bones Transverse, oblique, short spiral • Some metaphyseal fractures Radial neck Proximal/distal humerus Proximal/distal femur
- 23. Femoral shaft Excellent results reported Comparable to traction and hip spica Comparable to plating Earlier rehabilitation Avoids discomfort
- 24. Forearm-unstable fractures • Beter results than casting. avoids plating
- 26. • Tibial shaft Good results less complications
- 27. • Humeral shaft
- 29. PRINCIPLES • Three-point support • More extended inner contact • Provides better stability
- 30. PROBLEMS • Wrong technique • Wrong nail size • Wrong patient • Wrong fracture
- 31. Take home message Is a minimally invasive, effective, and safe method for managing long bone fractures in paediatric patients. It offers excellent stability through elastic fixation, allows early mobilization, and preserves the growth potential of the bone. When performed with proper technique and patient selection, it yields predictable outcomes with minimal complications.
- 32. •Thank you