{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:54:00Z","timestamp":1762080840573,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:00:00Z","timestamp":1670630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Elastic stable intramedullary nailing (ESIN) is the gold standard for non-overweight children aged 6\u201312 years. However, the complication rate using elastic stable intramedullary nailing is considerably high. Nevertheless, the question arises of whether the indication for elastic stable intramedullary nailing therapy can be extended and which factors must be taken into account when determining the indication. Methods: A retrospective chart review of patients &lt;18 years admitted with diaphyseal femur fracture at a Level I Trauma Center in Germany between 2005 and 2017 was performed. In total, 118 patients were included. For the classification of femur fractures in children, the AO Pediatric Comprehensive Classification of Long-Bone Fractures (AO-PCCF) was applied. Results: Simple oblique fractures (32-D\/5.1) occurred in most of the patients. Patients with simple oblique fractures were significantly younger compared to patients with simple transverse (32-D\/4.1) or multifragmentary (32-D\/5.2) fracture type according to the AO Pediatric Comprehensive Classification of Long-Bone Fractures. Most patients were treated with elastic stable intramedullary nailing (68 patients, 58%). Although children treated with elastic stable intramedullary nailing were older than those treated conservatively (25%, n = 29, mean age 1.5, median age 1.0), the children in the elastic stable intramedullary nailing group were comparatively young (range 1\u201312 years, mean age 5.4, median age 5). A total of 32 children below the age of 6 years were treated with elastic stable intramedullary nailing. Complications were more frequent in patients with overhead extension (50%) compared to conservative treatment with a spica cast (17%) or elastic stable intramedullary nailing (15%). Conclusions: Elastic stable intramedullary nailing therapy was associated with a low complication rate and was, therefore, a safe and frequently used treatment strategy in diaphyseal femur fractures with satisfactory results, even though the age groups were expanded in favor of younger patients.<\/jats:p>","DOI":"10.3390\/jcm11247345","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T04:34:20Z","timestamp":1670819660000},"page":"7345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diaphyseal Femur Fractures in Children and Adolescents\u2014Opportunities and Limitations of the ESIN Technique"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1474-0785","authenticated-orcid":false,"given":"Miriam","family":"Kalbitz","sequence":"first","affiliation":[{"name":"Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany"},{"name":"Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University Hospital Ulm, 89081 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University Hospital Ulm, 89081 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birte","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, Goethe University of Frankfurt, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-9006","authenticated-orcid":false,"given":"Benjamin","family":"Mayer","sequence":"additional","affiliation":[{"name":"Institute for Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ina","family":"Lackner","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Pressmar","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/j.injury.2013.02.012","article-title":"Paediatric femoral shaft fractures: What are the concomitant injuries?","volume":"44","author":"Dodd","year":"2013","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1542\/peds.2004-1064","article-title":"Childhood Femur Fractures, Associated Injuries, and Sociodemographic Risk Factors: A Population-Based Study","volume":"115","author":"Rewers","year":"2005","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/01.bpo.0000230335.19029.ab","article-title":"Epidemiology and Mechanisms of Femur Fractures in Children","volume":"26","author":"Loder","year":"2006","journal-title":"J. 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