FIGURE 4.

A 3-year-old boy sustained a subtrochanteric transverse femoral fracture. (A) Spiral fracture of the distal tibial shaft and buckle fracture of the distal fibula shaft after having been run over by a motor vehicle. Primarily, all fractures were treated nonoperatively with a hip spica cast. After 3 days of hip spica cast treatment, the angulation at the fracture site was not corrected (B), and the decision was made to reduce and stabilize the femur fracture using the ESIN technique (C). Radiological union of the femur fracture was documented 1 month postoperatively. We noted massive callus formation bridging at the fracture site (D). ESIN = elastic stable intramedullary nails/nailing.