- Technique:
- position: supine;
- ulnar fractures: arm pronated across the chest;
- radial fractures: arm abducted and in neutral rotation;
- fractures of both bones of forearm are carried out thru separate
incisions, w/ 2-2.75 inch skin brige left between two;
-
Approach to the Ulna:
- parallel and slightly volar to the subcutaneous crest of the ulna;
- w/ Henry approach, make the incision more dorsally and with the Thompson approach
make the incision more volarly (to maximize the skin bridge);
- note that volarly placed incisions, may cause incisional discomfort when the
patient rests the forearm on a table (not the case w/ more dorsal incisions);
-
Approach to the Radial Shaft:
-
Anterior Approach: (Henry);
- anterior approach is required if
compartment syndrome is present;
- some surgeons prefer this approach for proximal 1/3 and distal 1/3 radial frx;
- proximally, the PIN is protected by the supinator, which facilitates
future plate removal;
- although this defies placing plate on the tension side (dorsal radius), soft
tissue coverage on volar side is better & bone contour is flat, making it
easier to apply plate;
- if the anterior approach to the radius is utilized, then the ulnar incision
should be made more dorsally;
-
Dorsal Approach (Thompson):
- some prefer dorsal approach for fractures of the middle third;
- main disadvantage is potential injury to
PIN;
- also danger to nerve if plate is removed through dorsal approach, since
scarring makes visualization of nerve is difficult, esp in proximal 1/3;
- note: if the dorsal approach to the radius is utilized, then the ulnar incision
should be placed more volarly inorder to maximize the skin bridge;
