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Name:
TENS Nail Paediatric Radius and Ulna
Description:
TENS Nail Paediatric Radius and Ulna
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Duration:
T00H20M22S
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https://cadmoreoriginalmedia.blob.core.windows.net/2a94922e-d826-49b5-be81-588b1da83e0d/TENS Nail Paediatric Radius and Ulna.mp4?sv=2019-02-02&sr=c&sig=G%2BbSEs65JUN57xNT9s1hkAGb%2BaYguJ%2BeiaEpO4vFylg%3D&st=2024-11-21T14%3A03%3A36Z&se=2024-11-21T16%3A08%3A36Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Well, with us today, I'm going to take you through a surgical procedure in which we are going to do a TENS nail of radius and ulna. Radius and ulna are the forearm bones, which are commonly broken in pediatric population and TENS nail is commonly used in pediatric diaphyseal fractures. I have already uploaded a video on TENS nail of femur and as there was plenty of request, about TENS nail of radius talar today, I'm going to upload the video of the same and I'm going to take you through step by step as how to do this procedure safely.
So our patient today is a 15-year-old boy who unfortunately fell down yesterday and sustained this forearm fracture. You can see the fracture is displaced as well as translated, I think you can see the faces open. So TENS nail is commonly used. I think the first thing the first question that we need to ask is what size nail we are going to use. So if you are putting a TENS nail in a single bone, then you aim to fill around 60% of the canal diameter, so you take an X-ray.
We don't have one on one x-ray, so I'm really not sure what it is, but here it is, measuring somewhere around four mm at the narrowest part. So just to give you an example, if the bone the canal diameter is 10 mm, then you need to use a 6mm TENS nail if you are using in a single bone radius or alarm. If you are using two TENS nail in a bones such as femar, then you aim to fill around 80% of the canal, so you aim to use two nails a forearm that will make it 8.
So this is the simple mathematics that we need to use. So on this occasion, it's measuring around four if it take 60% of four, it's coming around 2.4. So hopefully we will use 2.5. But keep an open mind, especially in the Centers where you don't get one on one X-ray. The X-rays could be magnified or it, and that can change the diameter of the nail.
At the moment, we are thinking of using a 2.5 mm nail for both radius and ulna. So TENS nail setup is extremely important. You can see deliberately I have made our operation table slightly at an angle rather than keeping it straight. All it does is it gives us more space and freedom to move our sphere. And if you're working in a small theater set setup, it just increases the size of your OT.
So the hand is. The screen will be on the opposite side. So that we have got unimpeded access when we are taking the sea, I'm sure the system will come on this side. Dr. Rashid and Dr. Cushman towards operating surgeons will be sitting on this side. And here is our trolley.
So this will be the data set up. So now our patient is prepped and ripped. We have applied the tourniquet, but we have not inflated it because if you're not going to open it up, I don't think tourniquet is necessary and we really have to open these fractures to reduce it. So we are not anticipating opening of the fracture. But we have applied a tourniquet just in case we need it.
I think the first step now will be to identify the entry point for our radius. So the first step is to take any metal work in this case, we have used the artery and take an X-ray of the distal radius to identify the entry point. Now in terms of entry point, what is the correct site of the entry point? So entry point normally should be around 2 centimeters distal to the faces.
That is the usual entry point. The entry point would be dorsal or entry point could be lateral. Now it's a personal preference, if you are taking a dorsal entry point, you go through the list as vertical. If you are taking a lateral entry point, you just make a small incision at the site of your preferred choice or do a dissection and then proceed.
I personally prefer lateral because the chances of irritation of extensor tendon is very little. All you need to be careful is to be mindful about superficial radial. So we have checked the position. This position looks good on this particular case because the fracture of the radius is quite proximal. So even if I want to go a bit more distal or proximal, I don't think that would matter.
However, if you are encountering a fracture of the distal part of the tibia, then try to make this entry point as distal as possible to the visys. But you have to be sure that you are at least 5mm distal to the visys. So now when you are starting up, I think for junior surgeons who are just taking up their career, it's extremely important that your entry is bang in the center on lateral.
If you gain experience, then you can slide 2 or three dorsal and slide 2 or 3 wooler and be certain how when you are starting up, take a lateral and do a skin mark to identify where you're going to start. So just to explain, we have marked, you can see there is a vertical skin mark. If Dr. Rush is going to put there, so that is our site from the visys, so we have marked this on AP and then again, we have taken a lateral, and when we check the lateral, this was the center.
Now the point at which these two lines meet, that will be the point at which you are going to make a incision. So just start and make a small incision roughly around one centimeter. Don't try to make it too narrow because you want to dissect it nicely with help of your dissecting scissors and artery. Just to be sure that you are close to the bone and you're not injuring the superficial radial, which is the only important structure here.
So we're just going to use an artery and do a gentle dissection till we reach the period stem. Now, some people may ask which we want to do first. Now, the most difficult bone that you anticipate during the surgery, you should do it first. However, some people will disagree with me, with me, but that is the principle I follow, and it's usually the radius, so I always start with the radius. So next step is that taken all.
Some people will use drillbit, but I will say never use drill use and all its much more control. It doesn't generate heat and it's much more easy to use. So the next step is to make your entry point to start vertically first and then take an X-ray. So now you can see that we have gone 90 degree to the bone, and that is what you should do because then you will not skid onto the bone and then gradually decrease the angle and I will show you what I mean.
So what to gradually start 90 degree and then slowly decrease the angle? And then try to make it more vertical. For your TENS nail to go, and I think we'll just check one more time. And some images looks really good. So when you are starting up, the most difficulty I see juniors struggling is that they make a good hole and then they struggle to put
the TENS nail, to find the hole, so the next step is now to take the oil out and put our TENS nail, I think junior people struggle to find the entry point. So one key is that your assistant should be ready to take the oil off and you should be ready with your TENS nail and be ready to put in the same direction. And that way, it's much easier to find your entry hole. So Dr. Cushman is going to take it out, and Dr. Rashid is going to insert the nail at the same time.
So once you're happy that you have the right feel, take an X-ray to make sure that you are inside the bone. On this occasion, it looks pretty good. So slowly with the twisting movement. Pass the nail. Now, the other question that people may ask is whether do you do the preventing or not? And I would say if you want to do prevent, it's OK, but I don't usually prevent because I feel it's unnecessary.
But preventing has been advocated by some, and a lot of people have refuted it that there is no real advantage of preventing when you're using just one nail. But if at all, you are using a preventing, just use it for ideas because otherwise pretty much straight, you don't need to prevent the wire for alarm. So now, as you all know, that there is a bend at the end of the nail and that bend is for you to be used to your advantage when you are negotiating this nail in a tight space.
So deliberately, we have kept this curve away from the cortex. So that when you push it, it slides away and then follows the track of the medullary cavity. If you put it the other way round, you will struggle because it's going to hit, it's going to engage in the cortex and it will struggle a lot. So this is the right way.
And then slowly, with the twisting movement, proceed upwards. So once you reach the position, which I showed you and see are, then usually it requires a little bit of hammering to negotiate the nail distally. Softer gentle tapping and rotating movement, you can see the wire is now gone distally, this is the point where you need to show some patience because this is the point where you might find some difficulty negotiating.
This is probably the difficult part of the operation, but once it is through now, the rest all should be pretty easy. So after negotiation, you will see you will reach a point where now the bend is towards the cortex, if you continue to hit, it may progress, but then it will be difficult. So all you need to do is to rotate that the handle and then you will see that the bend is away from the cortex. You can bend a little bit more and then start hammering it, and it will proceed further.
So now, after negotiation, our nail has gone up to the fracture site. And now it's just a matter of reduction and then passing the nail. I think one thing I forgot to tell was, you know, the age limit in which this is indicated. So the lower age limit for using the TENS, most people will say, is around three to four years and the upper limit is around 13 to 15 years.
However, there are certain times where we use it in the adults as well, but the routine age group in which we should be using is from three years to around 15 years. So the reduction is the key in getting a closed reduction and passing of the wire closed. So we are just applying a ligament or taxes, so there is a traction and account attraction because it's a proximal third fracture.
We have kept the arms supine. And then we will check the position and see how it looks. So this is how it looks. So still, there is some translation now we can use the bend of the TENS in order to pass across. At the moment it is, I think, facing this way. So if it turns this way across at this site, then it will follow. The middle cavity, and that way, it should reduce or go on to the proximal fragment easily.
So now our nail has gone up to the fracture site, so we are going to curve. The tip towards. The lateral side, and you can see Dr. Cushman will try to push this fragment slightly medially. So that we are able to negotiate the nail into the metal cavity approximately. So now we have rotated the nail towards the lateral side, and we'll hammer it now.
So now you can see that because we bend the tip of our TENS nail towards the lateral side, if you can see this thumb of Doctor shoulder, ideally she should not be seeing it. But he was pushing this fragment towards the medial side and it looks as if now we are into the proximal fragment will confirm or confirm it on a lateral view, just to be sure that we are in the right place.
OK so on this occasion, we are fine that on lateral also, it looks pretty good. However, if it was looking good on AP. And in lateral, it was wearing dorsal or volar. Then keep the traction on AP and then reduce the fracture on the lateral. Then you don't need an AP because on AP, you know, if you are giving traction, the alignment is good. So all you need is to focus on lateral and then reduce it and then pass that test.
It's very hard to explain everything here, but that is the philosophy. So how far to take the nail on this occasion, we have taken quite far, we have still left a couple of centimeters. This is because when we cut the nail later on, we still have some space for nail to be hammered because you don't want your nail to be prominent and irritating the soft tissue or the tendons.
So now we have passed our TENS nail in radius from distal to proximal. Now we will pass the nail from proximal to distal. So same way we want to mark the entry point of the ulna. So it's usually centimeters distal to the visys, and we do the same thing. We mark AP and lateral to see where we are going to make our incision.
So this is what I meant. You draw a line here you are a couple of centimeter distal and here on lateral view are in line with the ulnar metal cavity. So again, we'll make a small incision with a 15 blade, and then we will dissect with an artery clip. And once we have done the dissection and we are ready to put our all, I'll be with you. So again, like this to start at 90 degree and then just go slowly.
And check the position on X-ray. Now, the position on the X-ray looks good, so like radius, we are just going to angle it on this occasion, we are starting proximal to distal will just increase the angle slowly so that we become in line with the ulnar shaft, so gradually drop down your hand and increase the angle. Like we did in the radius.
So not like liking radius, one person will take the oil out, the other person will be ready to find the hole and put he TENS nail in the hole. So like in radius, we will use this curve to our advantage. And as you at this point of time, the cavity is quite wide, you're going through the metaphysically area. But once you come to the cortical area, use your bent to your advantage and keep rotating it by taking sequential x-ray, as we did in radius.
I don't want to reinforce it again and again, but keep changing the direction. So as to pass the TENS nail easily. So like in radius. This bend is now hitting the cortex. So as I said, you just need to turn it and take this bend away from the cortex and then keep either the rotating force or gentle melting to take it up to the fracture site.
So now we have got our nail up to the fracture site. Now, as we did in radius again, we are going to apply a longitudinal traction and then take an AP and a lateral view to assess our deformity and to correct it with appropriate forces and then negotiate the nail into the distal fragment of the ulna. So now we have taken a lateral or an oblique, and this is the app we have used.
The force is in order to neutralize it. The reduction looks OK, now we will just pass. The wire with a mallet, and we will see whether we succeed or not. Now looking at the AP and the lateral, our guide wire is in sight. There will be occasions where you have soft tissue into position or it's an old fracture and despite trying, you are unable to reduce it.
So there is no harm in making a small incision, opening it up and reduce it and proceed with the TENS nail. So now we have passed our guidewire, we are still left few centimeters. And this is because we will cut the TENS nail and we will push it in. So leave a few centimeters so that you cut it long and then push it in to bury the nail so that it's not prominent and it's not irritating the soft tissue.
So one small thing that most people don't keep in mind is that if you remember this tip. They should face towards the same direction. So if they face the same direction, then it tenodesis the atrocious membrane. It helps in a good reduction. So if you see the bend here is facing towards the radius, so it's pointing this way. And here.
It is pointing towards ulnar so both the bench should be pointing towards each other. So as to keep the tension of the antrocious membrane. So next step now will be to cut both TENS nail and then bury it inside. So the last bit is to bury the TENS nail inside. And then it's just a matter of putting a few stitches. I don't put any plaster after this operation as I feel it's unnecessary.
Patient can mobilize from the next day, so you can see this is our skin close. We have put a single stitch on the radial site and a single stitch on the ulnar side, so you can do this operation by a really small incision. We'll put some dressing and patients will start mobilizing from tomorrow. So we was this was a demonstration on how to do it TENS of radius and ulnar.
I think the key message is that you should use the right size nail if you want this operation to succeed and to avoid complication. And as I said before, if you're using a single TENS nail, try to fill at least 60% of the canal diameter. On this occasion, we want it to use a 2.5 nail. However, because we don't get one on one x-ray, they are usually under magnified or magnified. We found that 2.5 needle would have been 10, and hence we used a three nail, which is the usual size that you would use in an adult, normally use 1.25 to around 2.5 mm pediatric population.
If you are struggling to reduce it closed, then there is no harm in opening it up. Just make a small incision and open it up and pass the needle. Try to address the most difficult fracture first. Usually, it's the radius. I always try to do the radius first. I hope this video will give you an insight about how to do this operation and will be a guide when you are doing this operation.
If you are a patient. This will help you to understand what happens in operation theater. If you like this video do give us the thumbs up. Do subscribe and do share our channel. Thank you.
Segment:0 .
Well, with us today, I'm going to take you through a surgical procedure in which we are going to do a TENS nail of radius and ulna. Radius and ulna are the forearm bones, which are commonly broken in pediatric population and TENS nail is commonly used in pediatric diaphyseal fractures. I have already uploaded a video on TENS nail of femur and as there was plenty of request, about TENS nail of radius talar today, I'm going to upload the video of the same and I'm going to take you through step by step as how to do this procedure safely.
So our patient today is a 15-year-old boy who unfortunately fell down yesterday and sustained this forearm fracture. You can see the fracture is displaced as well as translated, I think you can see the faces open. So TENS nail is commonly used. I think the first thing the first question that we need to ask is what size nail we are going to use. So if you are putting a TENS nail in a single bone, then you aim to fill around 60% of the canal diameter, so you take an X-ray.
We don't have one on one x-ray, so I'm really not sure what it is, but here it is, measuring somewhere around four mm at the narrowest part. So just to give you an example, if the bone the canal diameter is 10 mm, then you need to use a 6mm TENS nail if you are using in a single bone radius or alarm. If you are using two TENS nail in a bones such as femar, then you aim to fill around 80% of the canal, so you aim to use two nails a forearm that will make it 8.
So this is the simple mathematics that we need to use. So on this occasion, it's measuring around four if it take 60% of four, it's coming around 2.4. So hopefully we will use 2.5. But keep an open mind, especially in the Centers where you don't get one on one X-ray. The X-rays could be magnified or it, and that can change the diameter of the nail.
At the moment, we are thinking of using a 2.5 mm nail for both radius and ulna. So TENS nail setup is extremely important. You can see deliberately I have made our operation table slightly at an angle rather than keeping it straight. All it does is it gives us more space and freedom to move our sphere. And if you're working in a small theater set setup, it just increases the size of your OT.
So the hand is. The screen will be on the opposite side. So that we have got unimpeded access when we are taking the sea, I'm sure the system will come on this side. Dr. Rashid and Dr. Cushman towards operating surgeons will be sitting on this side. And here is our trolley.
So this will be the data set up. So now our patient is prepped and ripped. We have applied the tourniquet, but we have not inflated it because if you're not going to open it up, I don't think tourniquet is necessary and we really have to open these fractures to reduce it. So we are not anticipating opening of the fracture. But we have applied a tourniquet just in case we need it.
I think the first step now will be to identify the entry point for our radius. So the first step is to take any metal work in this case, we have used the artery and take an X-ray of the distal radius to identify the entry point. Now in terms of entry point, what is the correct site of the entry point? So entry point normally should be around 2 centimeters distal to the faces.
That is the usual entry point. The entry point would be dorsal or entry point could be lateral. Now it's a personal preference, if you are taking a dorsal entry point, you go through the list as vertical. If you are taking a lateral entry point, you just make a small incision at the site of your preferred choice or do a dissection and then proceed.
I personally prefer lateral because the chances of irritation of extensor tendon is very little. All you need to be careful is to be mindful about superficial radial. So we have checked the position. This position looks good on this particular case because the fracture of the radius is quite proximal. So even if I want to go a bit more distal or proximal, I don't think that would matter.
However, if you are encountering a fracture of the distal part of the tibia, then try to make this entry point as distal as possible to the visys. But you have to be sure that you are at least 5mm distal to the visys. So now when you are starting up, I think for junior surgeons who are just taking up their career, it's extremely important that your entry is bang in the center on lateral.
If you gain experience, then you can slide 2 or three dorsal and slide 2 or 3 wooler and be certain how when you are starting up, take a lateral and do a skin mark to identify where you're going to start. So just to explain, we have marked, you can see there is a vertical skin mark. If Dr. Rush is going to put there, so that is our site from the visys, so we have marked this on AP and then again, we have taken a lateral, and when we check the lateral, this was the center.
Now the point at which these two lines meet, that will be the point at which you are going to make a incision. So just start and make a small incision roughly around one centimeter. Don't try to make it too narrow because you want to dissect it nicely with help of your dissecting scissors and artery. Just to be sure that you are close to the bone and you're not injuring the superficial radial, which is the only important structure here.
So we're just going to use an artery and do a gentle dissection till we reach the period stem. Now, some people may ask which we want to do first. Now, the most difficult bone that you anticipate during the surgery, you should do it first. However, some people will disagree with me, with me, but that is the principle I follow, and it's usually the radius, so I always start with the radius. So next step is that taken all.
Some people will use drillbit, but I will say never use drill use and all its much more control. It doesn't generate heat and it's much more easy to use. So the next step is to make your entry point to start vertically first and then take an X-ray. So now you can see that we have gone 90 degree to the bone, and that is what you should do because then you will not skid onto the bone and then gradually decrease the angle and I will show you what I mean.
So what to gradually start 90 degree and then slowly decrease the angle? And then try to make it more vertical. For your TENS nail to go, and I think we'll just check one more time. And some images looks really good. So when you are starting up, the most difficulty I see juniors struggling is that they make a good hole and then they struggle to put
the TENS nail, to find the hole, so the next step is now to take the oil out and put our TENS nail, I think junior people struggle to find the entry point. So one key is that your assistant should be ready to take the oil off and you should be ready with your TENS nail and be ready to put in the same direction. And that way, it's much easier to find your entry hole. So Dr. Cushman is going to take it out, and Dr. Rashid is going to insert the nail at the same time.
So once you're happy that you have the right feel, take an X-ray to make sure that you are inside the bone. On this occasion, it looks pretty good. So slowly with the twisting movement. Pass the nail. Now, the other question that people may ask is whether do you do the preventing or not? And I would say if you want to do prevent, it's OK, but I don't usually prevent because I feel it's unnecessary.
But preventing has been advocated by some, and a lot of people have refuted it that there is no real advantage of preventing when you're using just one nail. But if at all, you are using a preventing, just use it for ideas because otherwise pretty much straight, you don't need to prevent the wire for alarm. So now, as you all know, that there is a bend at the end of the nail and that bend is for you to be used to your advantage when you are negotiating this nail in a tight space.
So deliberately, we have kept this curve away from the cortex. So that when you push it, it slides away and then follows the track of the medullary cavity. If you put it the other way round, you will struggle because it's going to hit, it's going to engage in the cortex and it will struggle a lot. So this is the right way.
And then slowly, with the twisting movement, proceed upwards. So once you reach the position, which I showed you and see are, then usually it requires a little bit of hammering to negotiate the nail distally. Softer gentle tapping and rotating movement, you can see the wire is now gone distally, this is the point where you need to show some patience because this is the point where you might find some difficulty negotiating.
This is probably the difficult part of the operation, but once it is through now, the rest all should be pretty easy. So after negotiation, you will see you will reach a point where now the bend is towards the cortex, if you continue to hit, it may progress, but then it will be difficult. So all you need to do is to rotate that the handle and then you will see that the bend is away from the cortex. You can bend a little bit more and then start hammering it, and it will proceed further.
So now, after negotiation, our nail has gone up to the fracture site. And now it's just a matter of reduction and then passing the nail. I think one thing I forgot to tell was, you know, the age limit in which this is indicated. So the lower age limit for using the TENS, most people will say, is around three to four years and the upper limit is around 13 to 15 years.
However, there are certain times where we use it in the adults as well, but the routine age group in which we should be using is from three years to around 15 years. So the reduction is the key in getting a closed reduction and passing of the wire closed. So we are just applying a ligament or taxes, so there is a traction and account attraction because it's a proximal third fracture.
We have kept the arms supine. And then we will check the position and see how it looks. So this is how it looks. So still, there is some translation now we can use the bend of the TENS in order to pass across. At the moment it is, I think, facing this way. So if it turns this way across at this site, then it will follow. The middle cavity, and that way, it should reduce or go on to the proximal fragment easily.
So now our nail has gone up to the fracture site, so we are going to curve. The tip towards. The lateral side, and you can see Dr. Cushman will try to push this fragment slightly medially. So that we are able to negotiate the nail into the metal cavity approximately. So now we have rotated the nail towards the lateral side, and we'll hammer it now.
So now you can see that because we bend the tip of our TENS nail towards the lateral side, if you can see this thumb of Doctor shoulder, ideally she should not be seeing it. But he was pushing this fragment towards the medial side and it looks as if now we are into the proximal fragment will confirm or confirm it on a lateral view, just to be sure that we are in the right place.
OK so on this occasion, we are fine that on lateral also, it looks pretty good. However, if it was looking good on AP. And in lateral, it was wearing dorsal or volar. Then keep the traction on AP and then reduce the fracture on the lateral. Then you don't need an AP because on AP, you know, if you are giving traction, the alignment is good. So all you need is to focus on lateral and then reduce it and then pass that test.
It's very hard to explain everything here, but that is the philosophy. So how far to take the nail on this occasion, we have taken quite far, we have still left a couple of centimeters. This is because when we cut the nail later on, we still have some space for nail to be hammered because you don't want your nail to be prominent and irritating the soft tissue or the tendons.
So now we have passed our TENS nail in radius from distal to proximal. Now we will pass the nail from proximal to distal. So same way we want to mark the entry point of the ulna. So it's usually centimeters distal to the visys, and we do the same thing. We mark AP and lateral to see where we are going to make our incision.
So this is what I meant. You draw a line here you are a couple of centimeter distal and here on lateral view are in line with the ulnar metal cavity. So again, we'll make a small incision with a 15 blade, and then we will dissect with an artery clip. And once we have done the dissection and we are ready to put our all, I'll be with you. So again, like this to start at 90 degree and then just go slowly.
And check the position on X-ray. Now, the position on the X-ray looks good, so like radius, we are just going to angle it on this occasion, we are starting proximal to distal will just increase the angle slowly so that we become in line with the ulnar shaft, so gradually drop down your hand and increase the angle. Like we did in the radius.
So not like liking radius, one person will take the oil out, the other person will be ready to find the hole and put he TENS nail in the hole. So like in radius, we will use this curve to our advantage. And as you at this point of time, the cavity is quite wide, you're going through the metaphysically area. But once you come to the cortical area, use your bent to your advantage and keep rotating it by taking sequential x-ray, as we did in radius.
I don't want to reinforce it again and again, but keep changing the direction. So as to pass the TENS nail easily. So like in radius. This bend is now hitting the cortex. So as I said, you just need to turn it and take this bend away from the cortex and then keep either the rotating force or gentle melting to take it up to the fracture site.
So now we have got our nail up to the fracture site. Now, as we did in radius again, we are going to apply a longitudinal traction and then take an AP and a lateral view to assess our deformity and to correct it with appropriate forces and then negotiate the nail into the distal fragment of the ulna. So now we have taken a lateral or an oblique, and this is the app we have used.
The force is in order to neutralize it. The reduction looks OK, now we will just pass. The wire with a mallet, and we will see whether we succeed or not. Now looking at the AP and the lateral, our guide wire is in sight. There will be occasions where you have soft tissue into position or it's an old fracture and despite trying, you are unable to reduce it.
So there is no harm in making a small incision, opening it up and reduce it and proceed with the TENS nail. So now we have passed our guidewire, we are still left few centimeters. And this is because we will cut the TENS nail and we will push it in. So leave a few centimeters so that you cut it long and then push it in to bury the nail so that it's not prominent and it's not irritating the soft tissue.
So one small thing that most people don't keep in mind is that if you remember this tip. They should face towards the same direction. So if they face the same direction, then it tenodesis the atrocious membrane. It helps in a good reduction. So if you see the bend here is facing towards the radius, so it's pointing this way. And here.
It is pointing towards ulnar so both the bench should be pointing towards each other. So as to keep the tension of the antrocious membrane. So next step now will be to cut both TENS nail and then bury it inside. So the last bit is to bury the TENS nail inside. And then it's just a matter of putting a few stitches. I don't put any plaster after this operation as I feel it's unnecessary.
Patient can mobilize from the next day, so you can see this is our skin close. We have put a single stitch on the radial site and a single stitch on the ulnar side, so you can do this operation by a really small incision. We'll put some dressing and patients will start mobilizing from tomorrow. So we was this was a demonstration on how to do it TENS of radius and ulnar.
I think the key message is that you should use the right size nail if you want this operation to succeed and to avoid complication. And as I said before, if you're using a single TENS nail, try to fill at least 60% of the canal diameter. On this occasion, we want it to use a 2.5 nail. However, because we don't get one on one x-ray, they are usually under magnified or magnified. We found that 2.5 needle would have been 10, and hence we used a three nail, which is the usual size that you would use in an adult, normally use 1.25 to around 2.5 mm pediatric population.
If you are struggling to reduce it closed, then there is no harm in opening it up. Just make a small incision and open it up and pass the needle. Try to address the most difficult fracture first. Usually, it's the radius. I always try to do the radius first. I hope this video will give you an insight about how to do this operation and will be a guide when you are doing this operation.
If you are a patient. This will help you to understand what happens in operation theater. If you like this video do give us the thumbs up. Do subscribe and do share our channel. Thank you.
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