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
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.
6. Aftercare following ESIN
Immediate postoperative care
Whilst the child remains in bed, the elbow and 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.
Ibuprofen and paracetamol should be administered regularly during the first 24-48 hours after surgery, with opiate analgesia for breakthrough pain.
Opiates should not be necessary after 48 hours and regular ibuprofen and paracetamol should be sufficient until 4-5 after injury or surgery.
The child should be examined if the level of pain is increasing or prolonged analgesia is needed.
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 is a late phenomenon.