{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:40:17Z","timestamp":1782906017219,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Ulm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Pediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3\u00a0years of age treated with ESIN for femur fractures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Inclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Between 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1\u2009\u00b1\u20090.7\u00a0years (13\u00a0months\u20132.9\u00a0years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0\u2009\u00b1\u20091.3\u00a0days. Radiographic controls were performed on day 1, 14 and 6\u00a0weeks after surgery if not otherwise specified or if complications occurred. 4.6\u2009\u00b1\u20091.2 (<jats:italic>n<\/jats:italic> 2\u20137) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4\u2009\u00b1\u20090.6\u00a0weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1\u00a0cm. In 10% of the patients, shortening after surgery of 1.7\u2009\u00b1\u20091.4\u00a0mm (0.3\u20133.1\u00a0mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1\u2009\u00b1\u20094.4\u00a0months (4\u201324\u00a0months). First independent mobilization was seen at an average of 3.4\u2009\u00b1\u20091.1\u00a0weeks (2\u20136\u00a0weeks) after surgery. Implant removal was performed after 3.2\u2009\u00b1\u20091.3\u00a0months (2\u20138\u00a0months). No refracture after implant removal occurred.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Early results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-01965-4","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T13:04:23Z","timestamp":1649423063000},"page":"3401-3407","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["ESIN in femur fractures in children under 3: is it safe?"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8176-5774","authenticated-orcid":false,"given":"Raffael","family":"Cintean","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Eickhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Pankratz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Strauss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Gebhard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Sch\u00fctze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"issue":"8","key":"1965_CR1","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1302\/0301-620X.102B8.BJJ-2019-1060.R3","volume":"102-B","author":"JE Gordon","year":"2020","unstructured":"Gordon JE, Anderson JT, Schoenecker PL, Dobbs MB, Luhmann SJ, Hoernschemeyer DG. 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