Elastically stable intramedullary nailing (ESIN) with TEN (Titanic elastic nail) or STEN


Elastic stable intramedullary nailing (ESIN, TEN, Prévot nailing) is a possibility of surgical treatment of various bone fractures. The surgical method is particularly suitable for treating childish fractures of the long tubular bones, such as the upper arm, forearm, as well as the upper and lower legs.

The technique involves inserting flexible titanium (TEN) or steel (STEN) nails into the broken bone. The nails are flat and angled at their tip. Using a special technique to insert the nails into the bone, they clamp each other inside the bone and thus lead to a stable connection between the two bone fragments.

The technique is particularly suitable for children, because they are extremely important for bone growth Growth plates be spared at ESIN. Bone growth is therefore not negatively affected when performing an ESIN. The affected bone can also be loaded again after a short time and no plaster of paris is necessary in the follow-up treatment.


Nowadays the ESIN mainly takes place at childish fractures their use. Especially with breaks in the long tubular bones ESIN is a popular therapy method. Fractures of the upper and lower arm as well as the thigh bone or the bones of the lower leg are therefore popular indications for performing an ESIN. It must be noted that in many cases bone fractures need to be treated with conservative therapy and only when the bone fragments are severely displaced can surgical therapy be considered.

The fact that especially childish fractures are treated with the ESIN is due to the fact that the important growth plates for children are spared and so that bone growth is not negatively affected by the therapy.

Recently, collarbone fractures have also been treated using the ESIN.

Not all types of bone fractures are suitable for performing an ESIN. For example, nailing should not be used if there is a fracture involving a joint.

It should also be ensured that the affected child is suitable for nailing. For example, it has been found that nailing broken bones in the upper or lower leg is not sufficiently stable in overweight children, which is why this technique cannot be recommended in this case.

Forearm fracture

The forearm is made up of two different bones: the spoke (medical: radius) as well as the Cubit (medical: ulna). Both bones belong to the tubular bones and are in principle suitable for performing an elastically stable intramedullary nailing. The fracture of the radius is one of the most common fractures in humans. In order not to endanger the growth of the broken bone, attempts are made in children to treat a broken bone of the forearm with the help of the ESIN.

The advantage of treating a forearm fracture with the ESIN is particularly the not necessary aftercare with a plaster of paris as well as the Possibility of early exposure of the forearm. It is recommended to carry out an ESIN in the case of a forearm fracture in children if the fractures are displaced and are not associated with significant injuries to the soft tissue.

Upper arm fracture

Of the Humerus (medical: humerus) belongs to the long tubular bones of the human skeleton. The humerus is rarely affected by fractures. Upper arm fractures in childhood are surgically treated using the ESIN if the bone fragments are in a certain misalignment.

Especially if there is a fracture of the humerus close to the elbow the advantages of the ESIN come into play. Important nerves that run around the broken upper arm are spared with the help of the ESIN technology and there are fewer complications after the operation. The affected arm can also be affected after the operation charged again promptly without having to put on a cast. Removal of the nails is recommended at a later point in time with a local anesthetic.

Femur fracture

Of the Thigh bone (medical: femur) is the largest bone in the human skeleton. Nevertheless, it can lead to a fracture of the bone, which often treated surgically must become. The type of fractures and their care differs in children and adults. Performing an ESIN is often the method of choice for children older than 3 years who have suffered a thigh fracture.

Since the nailing is partly a Extension of each affected leg nailing application should cause a number of different problems, and this can cause a number of different problems be careful before the age of ten.

The main advantages of the ESIN are that the affected children can put weight on the treated leg again early after the operation, thus avoiding misalignments and complications of prolonged immobilization.

In cases where there is severe instability of the bone fragments or significant soft tissue damage, external fixation of the bone parts (external fixator) can be used in addition to the ESIN.

break of collarbone

The Collarbone (medical: clavicula) represents the bony connection between on one side the shoulder blade and on the other side the breastbone and plays with movements in the Shoulder joint an important role. Because it is a relatively fragile and exposed bone, broken collarbones are not uncommon.

One possibility break of collarbone treatment consists of elastic, stable intramedullary nailing. The broken collarbone has recently become one of the Main indications for performing this technique. In contrast to the other indications, ESIN is also often used in adults with a broken collarbone. This is the case when the middle of the collarbone, the bone shaft, is broken. Only then can sufficient stability be achieved using nailing.

However, it is not always necessary to surgically treat a broken collarbone. In many cases, conservative therapy can achieve the desired success without having to take the risk of possible complications. The precise indication and experience of the attending physician are therefore important for the success of the therapy.