Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft

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Glossary

ESIN entry points (ulna)
Proximal lateral (radial) entry point for the ulna enlarge

Proximal lateral (radial) entry point for the ulna

Determine the correct entry point by palpating 1 cm lateral to the dorsal ulnar rim and 3 cm from the olecranon tip and verify it with an image intensifier.

Perform a stab incision down to the bone.


Pitfall: Entry point through the olecranon enlarge

Pitfall: Entry point through the olecranon

Do not introduce the nail through the olecranon.

This does not enhance fixation and causes troublesome soft-tissue irritation and discomfort to the child.


Distal medial entry point for the ulna enlarge

Distal medial entry point for the ulna

Use an image intensifier to determine the correct entry point.

This lies on the medial side of the ulna, 1 cm proximal to the growth plate.

Start the skin incision at the level of the entry point and extend it 2 cm distally.

If an image intensifier is not available, it is safer to use the proximal entry point.


Distal medial entry point for the ulna enlarge

Use small scissors or a surgical clip and small retractors to dissect to the bone under direct vision.

Be careful not to injure the dorsal branch of the ulnar nerve or the basilic vein.


Wound closure

Close skin and subcutaneous tissue with fine resorbable sutures (this avoids distress to the child when removing nonabsorbable sutures).

v1.0 2018-11-28