Indications Indications ORIF of ulnar fractures ulnar osteotomy ulnar lengthening (Kienbock's disease) ulnar shortening (for radial malunion) osteomyelitis and tumors of ulna Internervous Plane Between ECU (PIN nerve) FCU (ulnar nerve) Preparation Anesthesia general supraclavicular/ infraclaviclar or axillary nerve block Position patient supine with arm placed across chest or elbow flexed while surgical assistant holds forearm vertically Tourniquet applied to upper arm Approach Incision palpate subcutaneous ulnar border of ulna make linear longitudinal incision over subcutaneous border of ulna length based on procedure Superficial dissection incise deep fascia in distal incision in line with skin incision divide plane between ECU and FCU dissect down to subcutaneous border of ulna at middle 1/3 of ulna must divide fibers of ECU to reach bone Deep dissection incise periosteum over ulna perform subperiosteal dissection In the proximal fifth of the ulna, part of triceps insertion must be detached to gain access to the bone Dangers Ulnar nerve proximally passes through two heads of FCU travels down forearm under FCU and on top of FDP protect by dissecting FCU subperiosteally Ulnar artery travels down forearm with ulnar nerve ulnar artery is radial to ulnar nerve protect by dissecting FCU subperiosteally