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.
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.
The standard ulnar approach offers good exposure along the whole ulnar shaft. The length of the incision depends on the exposure needed.
The proximal third of the shaft of the ulna and the proximal two thirds of the shaft of the radius can be reached by using a single incision.
The main drawback of this combined approach is an increased risk of synostosis.
This approach gives good exposure for fractures that include proximal ulnar shaft fractures and disorders of the radial head. It can be used for Monteggia injuries with persistent displacement of the radial head after anatomical reduction and fixation of the ulnar fracture.
Approaches to the distal radioulnar joint (DRUJ) become necessary in cases in which ulnar head dislocations, in the context of Galeazzi injuries, cannot be reduced closed.
The forearm anatomy is complex due to the presence of three major neurovascular bundles.
With the patient in supine position and the arm in pronation on an arm table, make a straight longitudinal, approximately 1 cm long incision at the tip of the olecranon.
The correct nail entry point and so the chosen approach depends on the nail type used.
The lateral approach can be used to access the radial head.
