Thirty Five Years of Intramedullary Flexible Nailing (FIN) in the Treatment of Children Fractures: Still a Young Method

The intramedullary flexible nailing (FIN) technique is a surgical concept of treatment of children long bones fractures. Advantages of FIN combine the respect of the fracture repair biology, the safety to the growth plates, and a mini invasive approach. In the past, many surgeons have used straight pins into the medullary canal. These unstable osteosynthesis were abandoned in favour of adult implants, but unsuitable for growing bones. If a Spanish publication reports the FIN in 1977, the School of Nancy helped the international development of this innovative method. To date, both industrialized countries and developing countries treat many children by the FIN technique. The stabilization of the fracture is due to two curved nails introduced into the medullary canal, away from the fracture. They must be bent in order to work in opposition inside the bone. Their diameter must be at least equal to 40% of the medullary canal. Compliance with these principles is the guarantee of good results. As a blacksmith, the surgeon must adapt the shape of the implants to the type of fracture. FIN Indications are diaphyseal fractures of femur, tibia, humerus, and both bones of the forearm. Some metaphyseal fractures can also benefit from this elegant fixation: in the radial neck fractures, the rate of epiphyseal necrosis virtually disappears with the FIN technique.