{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:17:17Z","timestamp":1792898237996,"version":"4.5.0"},"reference-count":32,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"5","license":[{"start":{"date-parts":[[2012,5,1]],"date-time":"2012-05-01T00:00:00Z","timestamp":1335830400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:p> Elastic stable intramedullary nailing (ESIN) is generally acknowledged to be the treatment of choice for displaced diaphyseal femoral fractures in children over the age of three years, although complication rates of up to 50% are described. Pre-bending the nails is recommended, but there are no published data to support this. Using synthetic bones and a standardised simulated fracture, we performed biomechanical testing to determine the influence on the stability of the fracture of pre-bending the nails before implantation. Standard ESIN was performed on 24 synthetic femoral models with a spiral fracture. In eight\u00a0cases the nails were inserted without any pre-bending, in a further eight cases they were pre-bent to 30\u00b0 and in the last group of eight cases they were pre-bent to 60\u00b0. Mechanical testing revealed that pre-bending to 60\u00b0 produced a significant increase in the stiffness or stability of the fracture. Pre-bending to 60\u00b0 showed a significant positive influence on the stiffness compared with unbent nails. Pre-bending to 30\u00b0 improved stiffness only slightly. <\/jats:p><jats:p> These findings validate the recommendations for pre-bending, but the degree of pre-bend should exceed 30\u00b0. Adopting higher degrees of pre-bending should improve stability in spiral fractures and reduce the complications of varus deformity and shortening. <\/jats:p>","DOI":"10.1302\/0301-620x.94b5.28247","type":"journal-article","created":{"date-parts":[[2012,4,23]],"date-time":"2012-04-23T13:59:45Z","timestamp":1335189585000},"page":"713-718","source":"Crossref","is-referenced-by-count":28,"title":["Increasing stability by pre-bending the nails in elastic stable intramedullary nailing"],"prefix":"10.1302","volume":"94-B","author":[{"given":"M. M.","family":"Kaiser","sequence":"first","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Zachert","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Biomechanics\rLaboratory, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Wendlandt","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Biomechanics\rLaboratory, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Eggert","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Stratmann","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Gros","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Schulze-Hessing","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rapp","sequence":"additional","affiliation":[{"name":"University Medical Center Schleswig-Holstein, Department\rof Paediatric Surgery, Campus L\u00fcbeck, Ratzeburger\rAllee 160, D-23538 L\u00fcbeck, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","first-page":"648","volume":"20","author":"Poolman RW","year":"2006","journal-title":"J Orthop Trauma"},{"key":"r2","unstructured":"von Laer L, Kraus R, Linhardt W. Pediatric fractures and dislocations. Fifth ed. Thieme: New York, 2007:281\u2013297 (in German)."},{"key":"r3","unstructured":"Leitlinien F. AWMF online: German Guidelines of the AWMF Study Group, 2008 http:\/\/www.awmf.org\/uploads\/tx_szleitlinien\/006-016l-S1_Femurschaftfraktur.pdf (date last accessed 19 January 2012) (in German)."},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2004.12.017"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B7.15620"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200101000-00003"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200307000-00006"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B10.17517"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200407000-00004"},{"key":"r10","first-page":"499","volume":"73","author":"Rapp M","year":"2011","journal-title":"Chir Praxis"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000164872.44195.4f"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00328"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000226280.93577.c1"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200107000-00005"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199908000-00028"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-001-0304-6"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2011.01.012"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-6-46"},{"key":"r19","unstructured":"No authors listed. 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