When the long bones of the arms and legs break in children, a simple cast won’t take care of the problem. In the old days, weeks and weeks of traction were required to pull the bones apart to reset them. Today curved, flexible rods are inserted down the middle of the long bone. This article reviews the use of these rods called Nancy nails.
In the past after traction for femur (thigh bone) fractures, children were put in a large (spica) cast from waist to toe. The spica cast was worn for two more months. Care for the child was difficult. Then surgical methods changed. It became possible to operate and fix the fracture with metal plates and screws. This method is still used in some places in the U.S.
With more single parent and two working-parent families, less cumbersome, less care-intensive treatment was needed. A surgeon in Nancy, France designed the new rods called elastic stable intramedullary nailing (ESIN). Intramedullary refers to the open canal inside the long bones. The nails or rods are pounded down into that space.
Although hospital time is shorter with ESIN, costs can be higher, especially if the nails are taken out in a second operation later. Surgeons agree that ESIN should be the new standard of care for femur and forearm fractures.
There are still large disagreements about whether or not the nails should come out later or stay in permanently. The author presents both sides of this argument. A perfect solution to the problem would be bioabsorbable rods that could stay in and dissolve over time when healing was complete. Our grandchildren may benefit from this type of implant.