Executive Editor: James Hunter

General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft 22u-D, 21r-E/M

ESIN

1. General considerations

Most of the ulnar fractures are in the proximal 1/3 so retrograde nailing of both bones is recommended.

The ESIN method involves closed reduction and internal fixation of both fractures with elastic nails or K-wires.

It can be used in any age group and any combination of fracture types.

Note: The risk of avascular necrosis of the radial head is higher after open reduction which should be avoided if possible.

2. Order of fixation

The ulna is treated first.

The radial neck fracture may spontaneously reduce after anatomical reduction and fixation of the ulna.

The radial neck fracture should also be fixed with an intramedullary nail to prevent redisplacement and to allow early joint mobilization.

3. Patient preparation

This procedure is normally performed with the patient in a supine position .

4. Reduction and fixation of the ulna

The steps for ulnar fracture fixation are described in the following ESIN procedure:

5. Reduction and fixation of radial head/neck

The steps required for proximal radial fracture fixation are described in the ESIN procedures for each fracture type:

6. Final assessment

Check the completed osteosynthesis with image intensification. These images should be retained for documentation or alternatively an x-ray should be obtained before discharge.

Make sure that the desired reduction has been achieved and the nails are of appropriate length.

Appendix

Shortcuts

Decision support

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v1.0 2018-11-28