Anterior Approach to Radius

Posterior Approach to Radius

Approach to the Ulna


Anterior Approach to Radius / Henry



- ORIF of radius fractures

- bone grafting of non unions 

- radial osteotomy 





- arm table

- tourniquet



- avoid full exsanguination to see vascular structures more easily

- supinate forearm

- straight incision from flexion crease just lateral to biceps tendon down to radial styloid


Internervous plane

- proximally between brachioradialis / BR and pronator teres / PT (median nerve)

- distally between the BR (radial nerve) and FCR (median nerve) 


Superficial Dissection

- proximally between PT and BR

- distally between FCR and BR

- begin distal and work proximally

- superficial radial nerve deep to BR  / retract radially with BR

- recurrent leash of Henry from the radial artery to BR just below elbow joint need to be ligated 

- radial artery beneath the BR in middle of wound and runs with two vena commitante

- may need to be mobilised and retracted medially particularly proximally and distally


Deep Dissection


Proximal Third

- follow biceps tendon to insertion on bicipital tuberosity

- just lateral to tendon is bicep bursa

- incise bursa to access proximal radius 

- radial artery superficial and medial to tendon

- fully supinate the forearm to expose the supinator and protect the PIN

- incise supinator along insertion on radius and lift subperiosteally (anterior oblique line)

- reflect from medial to lateral

- 25% of patients: PIN in contact with radial neck / thus take care with retractors 


Middle third

- anterior aspect covered by PT and FDS

- insertion of PT into radius exposed by pronating forearm

- detach PT from insertion along with FDS subperiosteally


Distal third

- FPL and Pronator Quadratus arise from the anterior aspect of distal third of radius

- incise periosteum of radius just lateral to PQ and FPL 

- subperiosteally dissect medially off radius

- this protects Median Nerve




- superficial radial nerve

- radial artery

- recurrent radial artery (anterior and posterior groups lie either side of radial nerve)


Posterior Approach to Radius / Thompson approach



- between ECRB and EDC proximally

- between ECRB and EPL distally



- ORIF of radial fractures

- non union of radial fractures 

- decompression of PIN





- supine with pronated forearm to expose the dorsal surface 



- from point just anterior to the lateral epicondyle to Lister's tubercle on dorsal radius 


Intermuscular plane 

- proximally is between the ECRB and EDC (PIN)

- distally the plane is between the ECRB and EPL (PIN)


Superficial Dissection

- deep fascia split in line of the skin incision

- identify plane between ECRB and EDC

- more obvious distally where the APL and EPB separate the two muscles 

- upper 1/3 contains the supinator at the base 

- proximal 1/3 then centres on exposure of the PIN between the two heads of supinator 

- PIN emerges 1cm proximal to distal edge of supinator 

- divides into branches to the extensor compartment 


Proximal to Distal PIN exposure

- detach origin of the ECRB and part of ECRL

- locate the PIN proximally and dissect out distally 


Distal to Proximal PIN exposure

- identify nerve as emerges from supinator and follow proximal 

- protecting all branches 


Deep Dissection

- once protected fully supinate the forearm to expose the supinator fully 

- strip the supinator subperiosteally to expose the proximal radius 

- in the middle 1/3 the APL and EPB blanket the approach as they cross the radius radially 

- they are mobilised by incising the superior and inferior borders 

- the distal 1/3 is exposed with subperiosteal dissection 



- 25% of cases have the PIN in touch with the radial shaft and so must be exposed 

- the nerve is protected with the supinator and reflected 



- proximally to expose the lateral epicondyle

- distally as the posterior approach to the wrist 


Approach to the Ulna



- ORIF of Ulna fractures 

- treatment of delayed or non union of ulnar fractures 

- osteotomy of Ulna

- ulnar lengthening / shortening





- place arm across chest of the supine patient 



- linear longitudinal incision along the subcutaneous border of the ulna 


Internervous plane 

- between the ECU and FCU 

- attach via shared aponeurosis onto subcutaneous border of the ulna

- cannot be separated at origin 

- fibers of ECU usually detached from the aponeurosis



- deep fascia incised along line of skin incision 

- continue to subcutaneous border of the ulna 

- proximally dissect between the Anconeus and FCU

- periosteum incised longitudinally 

- in proximal 1/5 part of triceps insertion released 



- the ulnar nerve lies on FDP deep to FCU

- safe as long as FCU stripped subperiosteally 

- in proximal dissections (1/5) should be identified between the two heads of FCU prior to stripping 

- ulnar artery also at risk 

- this incision also able to be extended proximally as posterior approach to humerus