- See:
-
Anterior Approach to Radial Shaft:
- @<c:\o\v\vuimgp -s c:\os\diagfor.1[Diagram
-
Plating Techniques:
- Discussion:
- incision begins distal to flexor crease of elbow & extends distally for approx
15 cm along the anterior border of
brachioradialis;
- brachioradialis is retracted laterally - avoid injury to superficial branch of
radial nerve which lies beneath;
-
pronator teres &
FCR form medial wall of incision;
-
radial artery is indentified as it is retracted medially;
- follow
biceps to its insertion into bicipital tuberosity of radius;
- laterally gain access to the adjacent bursa which allows exposure of proximal
part of shaft of the radius;
- deepen wound on the lateral side of the biceps tendon inorder to avoid
radial artery which lies superficial & medial to the tendon at this point,
- Identification of Posterior Interosseous Nerve:
- posterior interosseous nerve is most vulnerable w/ this approach;
- need to identify the nerve by first identifying
supinator; thru which
PIN passes on its way to posterior compartment of forearm;
- proximally, fibers of
supinator are identified as are fibers of
pronator teres which will be seen more distally passing over
supinator in opposite direction;
- effort is to preserve insertion of pronator teres, but it can be
detected and replaced if necessary;
- inorder to displace nerve posterolaterally (away from surgical area),
supinate forearm, & expose the insertion of supinator muscle into
anterior aspect of radius
- incision is made into periosteum along line of junction of supinator
& pronator teres, & bone is exposed by subperiosteal dissection;
- subperiosteally dissect supinator muscle along line of its broad insertion
- continue dissection laterally, stripping muscle off bone;
- lateral retraction of supinator lifts the
PIN aways from operative field;
