Anatomy of the distal forearm
A thorough knowledge of the anatomy around the wrist is essential. The following images give a short introduction.
In general, there are two palmar surgical approaches to the distal radius– a modified Henry approach to the radius and a more ulnar approach, designed to expose the median nerve as well as the distal radius.
Dorsal approaches (as illustrated A-D) can be chosen between the different extensor compartments (as illustrated I-VI), as dictated by the specific fracture pattern. In this module the dorsal approach through the third extensor compartment (B) is described in detail.
The modified Henry approach uses the plane between flexor carpi radialis tendon and the radial artery.
The ulnar shaft and the fracture gap between the ulnar styloid and the distal metaphysis are usually easily palpated.
A straight, longitudinal incision is made over the distal ulna, between the tendons of the extensor and flexor carpi ulnaris.
This extended dorsal approach can be used for wrist fusions or for joint-spanning plate fixation of comminuted intra-articular distal radius fractures.