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.
7. Aftercare following ESIN
Immediate postoperative care
Whilst the child remains in bed, the forearm should be elevated on pillows to reduce swelling and pain.
They should be encouraged to use the arm.
Cast immobilization is not necessary and hinders early recovery of joint movement.
For Monteggia lesions treated with ulnar nailing, the forearm may be immobilized in a cast in the position of maximum stability of the radiocapitellar joint for 2-4 weeks.
Ibuprofen and paracetamol should be administered regularly during the first 4-5 days of injury, with additional oral narcotic medication for breakthrough pain.
If pain is increasing the child should be examined.
The child should be examined regularly, to ensure finger range of motion is comfortable and adequate.
Neurological and vascular examination should also be performed.
Compartment syndrome should be considered in the presence of increasing pain, especially pain on passive stretching of muscles, decreasing range of active finger motion or deteriorating neurovascular signs, which are a late phenomenon.