Dorsal Approach to Radius

The Dorsal approach to radius also called Thompson approach, provides good access to the entire dorsal aspect of the radial shaft.

 

  • The Dorsal approach to radius is used for:
    1. ORIF of radial shaft fractures using extensor side of bone.
    2. Treatment of delayed union or nonunion of fractures of the radius .
    3. Access to the posterior interosseous nerve as it passes through the arcade of Frohse for:
      • nerve paralysis.
      • resistant tennis elbow.
    4. Radial osteotomy.
    5. Osteomyelitis and bone tumor resection/biopsy.

 

 

  • Place the patient in the Supine position:
    1. If the arm is abducted to the side on an arm board, the forearm should be pronated.
    2. If the arm is adducted across the chest, the forearm should be supinated,
      • If the ulna must be approached as well as the radius, this position will allow easier access to the ulna through a separate incision.

  • Landmarks:
    • Proximal:
      • Lateral epicondyle of the humerus.
    • Distal:
      • Dorsoradial tubercle (Lister’s tubercle).
  • Incision:
    • Starting point is anterior and distal to the lateral epicondyle of the humerus,
    • straight or gently curved incision along the dorsolateral aspect of the forearm,
    • be aware of superficial radial nerve and cephalic vein distally.
    • end incision just distal and ulnar to Lister’s tubercle.

  • The Internervous plane for the Dorsal approach to radius (Thompson approach) is:
    • Proximally between:
      • Extensor carpi radialis brevis muscle (ECRB): innervated by the radial nerve.
      • Extensor digitorum communis muscle (EDC): innervated by the posterior interosseous nerve.
    • Distally between:
      • Extensor carpi radialis brevis muscle (ECRB): innervated by the radial nerve.
      •  extensor pollicis longus muscle (EPL): innervated by the posterior interosseous nerve.

  • Proximal third:
    • Incise fascia in line with skin incision using interval between extensor carpi radialis brevis muscle (ECRB) and the extensor digitorum communis muscle (EDC) to reveal supinator muscle.
  • Middle third:
    • Identify the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) emerging between extensor carpi radialis brevis muscle (ECRB) and the extensor digitorum communis muscle (EDC).
  • Distal third:
    • Undermine the abductor pollicis longus (APL) and extensor pollicis brevis tendons medially to identify plane between extensor pollicis longus and extensor carpi radialis brevis muscle (ECRB).

  • Proximal third:
    • Identify the insertion of supinator by turning arm into full supination,
    • supination moves the posterior interosseous nerve away from area of deep dissection.
    • incise insertion of supinator along radius and subperiosteally strip supinator off bone to expose proximal third of radius.
    • for more proximal exposures, two deep approaches exist to protect posterior interosseous nerve:
      • dissecting proximal to distal:
        • detach origin of extensor carpi radialis brevis muscle (ECRB) and
        • extensor carpi radialis longus muscle (ECRL) from lateral epicondyle and identify and dissect posterior interosseous nerve  as it enters supinator muscle.
      • dissecting distal to proximal:
        • identify nerve as it exits supinator and dissect it proximally out of supinator substance.
  • Middle third:
    • Make incision along superior and inferior borders of abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
    • retract them off bone to expose middle third of radius.
  • Distal third:
    • separating the extensor carpi radialis brevis muscle (ECRB)and extensor pollicis longus (EPL) will directly lead to the lateral border of the radius.
    • part of the interosseous membrane may have to be removed to approach the radius.

  • The dorsal approach to radius (Thompson approach) can be extended to the dorsal side of the wrist ( Dorsal Approach to the Wrist ).
  • Dorsal approach to radius (Thompson approach) can be extended proximally to expose the lateral epicondyle of the humerus ( Lateral Approach to Distal Humerus ).

The structures at risk during dorsal approach to radius (Thompson approach) include:

  1. Posterior interosseous nerve (branch of radial nerve):
    • Injury usually occurs from retraction.
    • In 25% of patients the nerve actually touches the dorsal aspect of the radius.
    • Plates placed high on the dorsal surface may trap the nerve.
    • Posterior interosseous nerve must be identified within the supinator muscle.
  2. Posterior interosseous artery:
    • Accompanies the Posterior interosseous nerve along the interosseous membrane in the proximal 1/3 of radius.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius dorsal approach to radius
Images Source:
0 0 vote
Rate Article !
SHARE ON
Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments

Orthopedic Approaches App

Special Test Application
Special Test Application