Approach to Anterior radius

Position

  • Supine
  • Radiolucent arm board
  • Exsanguinate & tourniquet

Landmarks

  • Biceps tendon
  • Mobile wad (BR, ECRL, ECRB)
  • Styloid process of radius

Incision

  • Straight longitudinal incision
  • Start: anterior flexor crease of elbow just lateral to biceps tendon
  • End: Styloid process of radius

Internervous Plane

  • Distally
    • BR radial nerve
    • FCR median nerve
  • Proximally
    • BR radial nerve
    • PT median nerve

Superficial Dissection

  • Fascia in line with skin incision
  • Distally
    • Identify & develop plane between BR & FCR
  • Proximally
    • Identify & develop plane between BR & PT
    • (NB median border of BR is surprisingly far across the forearm)
  • Start distally & work proximally
  • Identify superficial radial nerve (under BR)
  • Proximally
    • BR receives recurrent radial artery — ligate
  • Retract BR & superificial radial nerve laterally
  • Retract FCR & radial artery medially 

Deep Dissection

  • Proximal third
    • Deep the wound lateral to biceps tendon
      • Biceps tendon inserts into bicipital tuberosity of radius
      • Radial artery is superficial & medial to biceps tendon
    • Locate supinator
      • Supinate forearm
        • Displaces PIN laterally & posteriorly
      • Incise supinator along the line of its broad insertion into anterior aspect of radius
      • Continue subperiosteal dissection
      • Avoid excessive retraction and don’t place retractors around radial neck
        • PIN very very close
  • Middle third
    • Pronate forearm
      • Exposes insertion of PT into lateral aspect of radius
      • Detach insertion & retract PT medially
  • Distal third
    • Detach PQ & FPL from attachments

Dangers

  • Nerves
    • PIN
    • Superficial radial nerve
  • Vessels
    • Radial artery
    • Recurrent radial arteries