Approach to Anterior radius

Position

supine
radiolucent arm board
exsanguinate & tournique

Landmarks

biceps tendon
mobile wad (BR ECRL ECRB)
styloid process of radius

Incision

Straight longitudinal incision
Start: anterior flexor crease of elbow just lateral to biceps tendon
End: Styloid process of radius

Internervous Plane

Distally
- BR radial nerve
- FCR median nerve
Proximally
- BR radial nerve
- PT median nerve

Superficial Dissection

Fascia in line with skin incision
Distally
- Identify & develop plane between BR & FCR
Proximally
- Identify & develop plane between BR & PT
- (NB median border of BR is surprisingly far across the forearm)
start distally & work proximally
identify superficial radial nerve (under BR)
Proximally
- BR receives recurrent radial artery
- Ligate
Retract BR & superificial radial nerve laterally
Retract FCR & radial artery medially

Deep Dissection

Proximal third
- Deep the wound Lateral to biceps tendon
  - Biceps tendon inserts into bicipital tuberosity of radius
  - Radial artery is superficial & medial to biceps tendon
- Locate supinator
  - SUPINATE forearm
    - Displaces PIN laterally & posteriorly
  - Incise supinator along the line of it's broad insertion into anterior aspect of radius
  - Continue subperiosteal dissection
  - DO NOT retract excessive or place retractors around radial neck
    - PIN very very close
Middle third
- PRONATE forearm
  - Exposes insertion of PT into lateral aspect of radius
  - Detach insertion & retract PT medially
Distal third
- Detach PQ & FPL from attachments

Dangers

Nerves
- PIN
- Superficial radial nerve
Vessels
- Radial artery
- Recurrent radial arteries