If elastic nails are not available, the ESIN method can be performed with long stainless-steel K-wires.

If closed reduction is not possible, an open reduction may be necessary.

This treatment can be performed if image intensifier is not available with fracture reduction under direct vision.

Advantages

• Cast-free rehabilitation
• Minimally invasive treatment
• Good alignment of fracture fragments
• Predictably good functional outcome

Disadvantages

• Image intensifier recommended
• Risk of nerve or tendon injury at entry point
• Risk of infection
• General anesthesia required
• Second anesthetic required for implant removal