Growth plate injury leading to Madelung-type deformity after ESIN in children: a case report and a narrative review of the literature

Background : Elastic Stable Intramedullary Nailing (ESIN) is widely used for pediatric forearm fractures due to its minimally invasive approach and reliable healing. However, when applied near the distal radius or ulna, ESIN may risk physeal injury during insertion or removal, potentially leading to growth arrest. Methods : We present a 12-year-old girl who developed a Madelung-type deformity years after ESIN removal, initially performed for diaphyseal forearm fractures. Early outcomes were satisfactory, but no long-term follow-up occurred. The deformity was discovered incidentally following unrelated trauma. Radiographs revealed volar tilt of the radius and dorsal subluxation of the ulna, consistent with physeal arrest. Results : A narrative review, conducted per guidelines, identified six studies describing similar complications. These reports emphasized careful entry point selection, technical precision, and the importance of long-term radiographic monitoring. Conclusion : Madelung-type deformity is a rare but serious complication of ESIN. Preventive strategies and structured follow-up are critical for early identification and management. Level of Evidence : Level IV