Clinical application of elastic intramedullary needle in the treatment of children

Pediatric orthopedic care has evolved significantly over the past few decades, especially in the management of long bone fractures. Among the many innovations that have transformed treatment outcomes, the elastic intramedullary needle has emerged as a preferred option for stabilizing fractures in growing children. This minimally invasive technique is specifically tailored to accommodate the anatomical and physiological differences between pediatric and adult patients, offering a blend of stability, flexibility, and biological compatibility.

This article explores the clinical application of the elastic intramedullary needle in pediatric fracture treatment, its core advantages, and how it supports fast and effective recovery in young patients.

Why Pediatric Fracture Management Requires Special Approaches

Differences in Bone Biology and Growth Potential

Children’s bones differ markedly from those of adults in both structure and function. Their bones are more porous, more flexible, and feature open growth plates (physes), which makes traditional fracture fixation methods—like plates and screws—less ideal. Any treatment that interferes with these growth plates can lead to long-term complications, including growth arrest or deformity.

This is where the elastic intramedullary needle becomes essential. Its design avoids the epiphyseal regions, preserving the natural growth trajectory of the bone while still ensuring excellent mechanical support.

Healing Speed and Remodeling Capacity

Children generally have a faster rate of bone healing and better remodeling potential. As such, they benefit more from fixation methods that offer early mobilization, minimal soft tissue disruption, and reduced risk of long-term complications. The elastic intramedullary needle is designed precisely with these goals in mind.

Key Features of the Elastic Intramedullary Needle

Flexible Yet Strong Internal Support

The elastic intramedullary needle is typically made from titanium or stainless steel and inserted into the medullary canal of long bones like the femur, tibia, humerus, or radius. Its elastic properties allow it to bend slightly, conforming to the natural curvature of the pediatric bone. This flexibility distributes stress evenly along the length of the bone, promoting physiological healing while minimizing the risk of implant failure.

Despite being flexible, the needle provides enough rigidity to stabilize most fracture patterns without external casting, allowing early mobilization in many cases.

Avoids Growth Plate Disruption

The strategic insertion points and careful intraoperative guidance ensure that the elastic intramedullary needle does not interfere with growth plates. This is a significant advantage over traditional methods that risk damaging these critical regions during screw or plate fixation. By sparing the physis, surgeons can preserve the child’s future growth potential and reduce the likelihood of secondary deformities.

Clinical Applications and Indications

Common Fracture Types Treated with Elastic Intramedullary Needle

This technique is highly effective for treating diaphyseal fractures of long bones, especially in children between the ages of 5 and 15. It is commonly used for:

Femoral shaft fractures

Tibial shaft fractures

Forearm fractures (radius and ulna)

Humeral shaft fractures

The method is especially helpful in closed or simple fracture patterns, though it has also been adapted for certain complex or comminuted fractures when accompanied by adjunct techniques.

Surgical Indications and Criteria

Not every fracture in a child requires surgical intervention. However, the elastic intramedullary needle is indicated when:

The fracture is unstable or significantly displaced

Closed reduction fails to maintain alignment

The patient requires early mobilization due to other medical needs

There is polytrauma requiring rapid fracture stabilization

Surgeons consider several factors, such as the child’s age, weight, fracture location, and overall health, before selecting this technique.

Surgical Technique and Postoperative Care

Minimally Invasive Insertion

The needle is inserted through small incisions made at metaphyseal regions, avoiding joints and growth plates. Under fluoroscopic guidance, one or two pre-bent needles are introduced into the medullary canal and passed across the fracture site. The elastic nature of the needle helps provide a three-point fixation system that offers both stability and flexibility.

This procedure typically results in shorter operating times, reduced blood loss, and minimal soft tissue damage.

Postoperative Recovery and Outcomes

Children treated with elastic intramedullary needles often experience faster recovery times. In many cases, weight-bearing is allowed within a few weeks, and physical therapy can begin early. The implant usually remains in place for 6–12 months, after which it may be removed once the bone has fully healed.

The outcomes are generally excellent, with a low risk of infection, implant failure, or malunion. Parents and healthcare providers often prefer this method because of its predictable recovery timeline and minimal long-term complications.

Benefits Compared to Other Fixation Methods

Early Mobilization and Return to Function

Unlike casting or traction, which require long periods of immobilization, the elastic intramedullary needle provides internal stabilization that supports early joint movement and functional recovery. Children can resume many daily activities soon after surgery, which reduces both psychological and physical stress.

Minimal Scarring and Lower Infection Rates

Because the technique involves small incisions and minimal hardware exposure, patients benefit from reduced scarring and a significantly lower risk of surgical site infections compared to open procedures involving plates or external fixators.

Cost-Effective and Reproducible

Elastic intramedullary nailing is a cost-effective procedure with a high success rate. Its relatively simple surgical technique and widespread availability make it an ideal solution in both high-resource and resource-limited healthcare settings.

Considerations and Potential Complications

Implant Migration or Irritation

Although rare, some children may experience skin irritation or discomfort at the insertion site, especially if the nail end is left protruding under the skin. This is usually resolved by trimming the nail ends or during scheduled removal.

Requires Technical Precision

Success with this method depends on proper preoperative planning, precise bending of the needle, and careful insertion. Inexperienced surgical technique can lead to complications such as malalignment or failure of fixation.

Conclusion – A Reliable Tool in Pediatric Orthopedics

The elastic intramedullary needle has revolutionized pediatric fracture care by offering a technique that is biologically respectful, minimally invasive, and highly effective. Its adaptability to growing bones, combined with a low complication profile and rapid recovery outcomes, makes it a top choice for orthopedic surgeons treating children’s long bone fractures.

By focusing on the specific needs of pediatric patients—namely, growth potential, rapid healing, and functional recovery—this method ensures that young patients can return to their normal activities with minimal disruption and long-term risk.

FAQ

Is the elastic intramedullary needle safe for all children?

It is generally safe for children aged 5 to 15 with specific types of long bone fractures. However, suitability depends on factors like bone maturity, fracture type, and overall health.

How long does the elastic intramedullary needle stay in the bone?

Most implants remain in place for 6 to 12 months and are removed after complete bone healing unless complications arise earlier.

Will the child need a cast after surgery?

In many cases, no cast is needed because the elastic intramedullary needle provides internal support. However, temporary splinting may be used based on the surgeon’s preference.

Does the needle affect future bone growth?

No, the elastic intramedullary needle is specifically designed to avoid growth plates, preserving natural bone development and preventing growth disturbances.