Approach to Posterior Radius

Thompson Approach

Position

• Supine
• Forearm pronated

Landmarks

• Lateral epicondyle of humerus
• Lister’s tubercle

Incision

• Straight longitudinal incision
• Start anterior to lateral epicondyle
• End just ulnar to Lister’s tubercle
• Use whatever part that is necessary

Internervous Plane

• Proximally
  • ECRB radial nerve
  • EDC PIN
• Distally
  • ECRB radial nerve
  • EPL PIN

Superficial Dissection

• Deep fascia
• Identify interval between ECRB & EDC distally

Deep Dissection

• Proximal 1/3
  • Radius is covered by supinator
    • PIN is between superficial & deep heads & arises 1cm proximal to distal edge
  • Identify & preserve PIN
    • Mobilise the nerve by carefully dissecting it through substance of supinator
  • Supinate forearm
    • Detach Supinator from origin subperiosteally
  • Middle 1/3 
    • Radius covered by 
      • APL
      • EPB
  • Distal 1/3
    • Identify interval between EPL and ECRB

Dangers

• PIN