Elastic Nail Fixation for growing bones
A minimally invasive technique using flexible titanium nails to stabilise long-bone fractures in children — without disturbing the growth plate.
What elastic nail fixation actually does
Two flexible titanium nails are pre-bent and inserted through small incisions at either end of the bone, then advanced across the fracture. Once in place, the nails spring outward against the inner bone wall, gripping it at three points along its length to hold the fragments aligned while they heal.
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Growth-plate friendly
Nails are inserted away from the growth plate and never cross it, so normal bone growth in children continues undisturbed.
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Three-point elastic fixation
The natural spring of the bent nails against the bone's inner surface provides stable, load-sharing fixation without rigid locking.
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No opening of the fracture site
Nails are passed under X-ray guidance without exposing the break directly, preserving the blood supply that speeds healing.
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Removed once healed
Unlike adult implants, elastic nails are routinely taken out in a short day procedure once the fracture has fully united.
Fractures this technique is built for
Thigh-bone breaks in children roughly 5–12 years old, the most common indication for elastic nailing.
Shin-bone breaks in growing children where a rigid implant isn't suitable but stable fixation is still needed.
Combined radius and ulna fractures in children that need alignment without opening the fracture site.
Upper-arm breaks in children where flexible nails give reliable fixation with minimal soft-tissue disruption.
Breaks close to the growing end of a bone where an implant must stay clear of the physis.
Fractures that shifted out of position in a cast and need surgical stabilisation to heal correctly.
What happens on the day of surgery
Every case is planned around the child's bone size and fracture pattern, but the sequence below is how most elastic nailing procedures are carried out.
Anaesthesia and nail sizing
Under general anaesthesia, the surgeon selects nail diameter and pre-bends both nails to match the bone's length and curve.
Small entry incisions
Two tiny incisions are made away from the growth plate, at the end of the bone, to create an entry point for each nail.
Fracture reduction
The fracture is realigned by gently manipulating the limb under fluoroscopy, without opening the break itself.
Nail advancement
Both pre-bent nails are advanced up the bone shaft in opposite curves, crossing the fracture and locking it in place by their spring tension.
Trimming and closure
Nail ends are trimmed and gently bent outside the bone for easy later removal, then the small incisions are closed with X-rays confirming final position.
What children and parents gain from elastic nailing
Tiny incisions mean less scarring and less disruption to muscle and soft tissue.
Nail entry points are placed to avoid any contact with the growing part of the bone.
Children typically mobilise sooner and get back to school and play quicker than with cast-only care.
Nails come out through the same small entry points once the bone has healed.
Dr. Lakshmikanth Reddy K
M.B.B.S., D.Ortho, DNB (Ortho) — Consultant Orthopaedic Surgeon, Specialist in Paediatric Trauma, Elastic Nail Fixation and Limb Reconstruction (Ilizarov Technique)
Paediatric fracture care led by a dedicated trauma specialist
Dr. Lakshmikanth Reddy K has extensive experience treating fractures in children, with a particular focus on elastic (flexible) nail fixation for femur, tibia, forearm and humerus fractures, always planned to protect the growth plate.
Every case is planned on pre-operative imaging to select the right nail size and entry points before surgery, with a straightforward rehabilitation and follow-up plan tailored to your child's age.
Frequently asked questions
Elastic nails are thin, flexible and inserted away from the fracture through tiny incisions, unlike a plate which sits on the bone or a rigid adult nail which locks it fully. They're specifically suited to a child's smaller, still-growing bones.
Assisted weight-bearing often starts within a few days. Most children return to school within 2–4 weeks and to full sports and play activity between 8 and 12 weeks, once healing is confirmed on X-ray.
Yes. Unlike some adult implants, elastic nails are almost always removed in a short day procedure once the fracture has fully healed, typically several months after the original surgery.
Yes, elastic nailing in children is almost always performed under general anaesthesia, and your paediatric anaesthesia team will discuss this with you beforehand.
As with any surgery, risks include infection, nail-end skin irritation, or slight loss of alignment — though these are uncommon, and rarely affect the child's long-term growth or function.
No. Entry points and nail position are deliberately planned to stay clear of the growth plate, so normal bone lengthening continues as the child grows.
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