Approach to Anterior Radius

Distal part of the volar (Henry) approach to the radius exposing the flexor carpi radialis tendon (A)
Distal part of the volar (Henry) approach to the radius exposing the flexor carpi radialis tendon (A). Retracting the tendon exposes pronator quadratus over the distal radius (B). Image from Nouh A, Amer M, El-Barbary H, Al-Feeshawy A, Abdel-Wahed M. Pronator quadratus-sparing volar plating of distal radius fractures, A prospective study. SICOT J. , 12. CC BY 4.0.
Approach to Anterior Radius, supinator muscle, from gray’s anatomy
Supinator muscle, from Gray’s Anatomy. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Position

  • Supine
  • Radiolucent arm board
  • Exsanguinate & tourniquet

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

Superficial Dissection

  • Fascia in line with skin incision
  • Distally
    • Identify & develop plane between BR & FCR
  • Proximally
    • Identify & develop plane between BR & PT
    • (NB medial 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 & superficial radial nerve laterally
  • Retract FCR & radial artery medially 

Deep Dissection

  • Proximal third
    • Deepen 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 its broad insertion into anterior aspect of radius
      • Continue subperiosteal dissection
      • Avoid excessive retraction and don’t 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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.