An understanding of the forearm surface anatomy particularly bony prominence and the cross-sectional contour is important for effective reduction and safe application of a cast.
The forearm anatomy is complex due to the presence of three major neurovascular bundles. Pin placement should avoid these structures.
In the distal radius use either the lateral or Lister’s tubercle entry point.
In the ulna use either the proximal lateral or the distal medial entry point.
The standard ulnar approach offers good exposure along the whole ulnar shaft. The length of the incision depends on the exposure needed.
The lateral (Kocher) approach can be used to access the radial head and the tip of the coronoid.
In pediatrics the most common use of this approach is open reduction of radial head/neck fractures.
In proximal ulnar injuries associated with radial head dislocation or radial neck fractures, both bones can be addressed through a lateral extension of the posterior skin incision (Boyd).