A technique for low-profile fixation of intraarticular proximal ulnar fractures using an intramedullary (IM) screw is described. A retrospective study of the early outcome of patients treated with this technique versus patients treated with 3.5-mm LCDP plating is also presented. The authors report on 33 patients managed with IM fixation and 16 managed with plate fixation. Mean follow-up time was 16 months. Injuries managed with IM fixation had decreased flexion contractures and improved pronation (p<.05) compared with injuries treated with plating. Elbow arc of motion and supination did not differ significantly. Hardware removal was required in 56% of injuries treated with plating and in 9% of injuries treated with IM fixation. Release for limited motion was required in about 25% of patients in both groups. Mayo scores did not differ between both groups. Low-profile intramedullary fixation facilitates wound closure and soft tissue management and results in similar short-term outcomes as plating. The authors recommend this technique for cases with significant soft tissue injury where plating may result in a difficult closure or prominent hardware.