Meticulous bony and soft tissue handling is paramount in optimizing prosthesis wear and minimizing neuropathic and phantom limb pain in patients with transradial amputations. Resection of 7 to 8 cm of radius and ulna proximal to the wrist joint preserves the majority of native forearm rotation. A pedicled pronator quadratus is a useful target for targeted muscle reinnervation and can provide additional distal soft tissue padding over the bone ends. Targeted muscle reinnervation or regenerative peripheral nerve interface techniques that place neurorrhaphy sites deep and distal within the forearm are preferred to minimize painful compressive sites with prosthesis wear.