1 General considerations topenlarge
Plating is the standard technique for treating forearm fractures in adults and is therefore best considered for skeletally mature or nearly mature children.
Children with open physes have thick active periosteum favoring stability and rapid healing with ESIN techniques. Where such techniques are unavailable plating may be used in younger children.
2 Principles topenlarge
Order of reduction and 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 be fixed with an intramedullary nail to prevent redisplacement and to allow early joint mobilization.
Combination with other treatment options
Plating the ulna may be combined with ESIN of the proximal radial fracture.
This allows for stable anatomical restoration of the forearm axis and early motion.
Choice of approach
The ulna is exposed by the direct approach between the flexor and extensor muscle compartments.
If there is residual displacement of the radial neck fracture after optimization of the ulnar correction, a closed reduction using ESIN or an open reduction should be performed.
Open reduction may also be necessary if an image intensifier is not available or if soft-tissue structures are trapped between the fragments.
A lateral approach to the proximal radius may be used to visualize the radial neck fracture.
3 Reduction and fixation of the ulna topenlarge
The steps for ulnar fracture fixation are described in the relevant plating procedure for each fracture type:
4 Reduction and fixation of radial head/neck topenlarge
The steps required for proximal radial fracture fixation are described in the ESIN procedures for each fracture type:
5 Final assessment topenlarge
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 plate is at the correct location, the screws and the nail are of appropriate length and the desired reduction has been achieved.
Stabilize the elbow at the epicondyles and check the forearm rotation.