ESIN entry point (pediatric distal 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.

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.

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