Preparation and positioning

Pronated position
Place the abducted arm on the operating side table with the forearm in pronation. In order to prevent compression of the ulnar nerve, place a cushion beneath the elbow.

Indications:

• Open reduction and internal fixation of the distal and middle third of the radial shaft
• Minimally invasive reduction and internal fixation of the distal radial shaft
• Open reduction and internal fixation of the ulna
• Insertion of proximal pins in the external fixation (both bones)

Pearl: arm across torso
Particularly when treating proximal ulnar fractures, it can be difficult to orientate the ulna for proper visualization. It might be preferable to place the arm over the patient’s chest (as for olecranon fractures),…

…or in an overhead arm gutter.

Supinated position
Place the abducted arm on the operating side table with the forearm in supination.

Indication
This position is indicated only for anterior plating of the radius, independent of the shaft segment, usually for an anterior approach (Henry).