Executive Editor: James Hunter

General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft

Overview

Forearm surface anatomy i

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.

Safe zones for pins (radius) i

The forearm anatomy is complex due to the presence of three major neurovascular bundles. Pin placement should avoid these structures.

Safe zones for pins (ulna) i

The forearm anatomy is complex due to the presence of three major neurovascular bundles. Pin placement should avoid these structures.

ESIN entry points (radius) i

In the distal radius use either the lateral or Lister’s tubercle entry point.

ESIN entry points (ulna) i

In the ulna use either the proximal lateral or the distal medial entry point.

Anterior approach (radius) i

The anterior (Henry) approach offers good exposure of the whole length of the radius. The length of the incision depends on the extent of exposure needed.

Posterolateral approach (radius) i

The posterolateral (Thompson) approach offers good exposure of the middle and distal thirds of the radial shaft. The skin incision lies straight down the dorsal aspect of the forearm and its length depends on the exposure needed.

Approach to the ulna i

The standard ulnar approach offers good exposure along the whole ulnar shaft. The length of the incision depends on the exposure needed.

Lateral approach (elbow) i

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.

Posterolateral approach (elbow) i

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).

Appendix

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v1.0 2018-11-28