1 General considerations topenlarge
Most ulnar fractures are in the proximal 1/3 and retrograde nailing of both bones is therefore 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 Patient preparation topenlarge
This procedure is normally performed with the patient in a supine position.
3 Entry points topenlarge
Entry point to the ulna
In the ulna use the distal medial entry point.
Entry points to the radius
The distal lateral entry point is in common use and shown in this example.
The dorsal entry point ((Lister’s tubercle)) is also well established and offers more versatile nail manipulation.
Find more details in ESIN entry points (radius).
4 Reduction and fixation topenlarge
Order of reduction and fixation
The ulnar fracture (1) is treated first.
The radial neck fracture (2) 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.
Reduction and fixation of the ulna
The steps for ulnar fracture fixation are described in the ESIN procedure (retrograde nail insertion).
Reduction and fixation of radial head/neck
The steps required for proximal radial fracture fixation are described in the ESIN procedure, illustrated with a 21r-E/1.1 fracture.
This technique is also appropriate for reduction and fixation of other proximal radial fracture types.
If an open reduction of the radial neck fracture is necessary a lateral approach to the proximal radius may be used.
5 Final assessment topenlarge
Check the completed osteosynthesis with image intensification. These images should be retained for documentation.
If an image intensifier is not available an x-ray should be obtained before discharge.
Make sure that the desired reduction has been achieved and the nails are of appropriate length.