20 surgical approaches to the forearm (nxpowerlite) · 2017-12-05 · surgical approaches to the...
TRANSCRIPT
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Surgical approaches to the forearm
Robert Strauch MDProfessor of Clinical Orthopaedic Surgery
Columbia University Medical Center
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The ulna is easy• Straight incision always—right
on bone• Don’t try to ORIF ulna through the
incision used to approach radius– Exception?—radial head replacement
done via the gap in proximal ulna fractures
• Straight incision always—right on bone
• Don’t try to ORIF ulna through the incision used to approach radius– Exception?—radial head replacement
done via the gap in proximal ulna fractures
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The radius approach
• Distal forearm:– Henry or FCR approach
• Middle and proximal forearm:– Dorsal Thompson approach
• Distal forearm:– Henry or FCR approach
• Middle and proximal forearm:– Dorsal Thompson approach
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Problems with radius approaches:
• Henry approach:– deep proximally and have to ligate stuff
– Keep forearm supinated to protect PIN
• Henry approach:– deep proximally and have to ligate stuff
– Keep forearm supinated to protect PIN
Thompson approach:
• Only thing to watch out for is PIN
• PIN is easy to find
• Find and protect it and bone is right there
• Only thing to watch out for is PIN
• PIN is easy to find
• Find and protect it and bone is right there
Henry approach
• Distally:
– between FCR and BR
– retract radial artery radially
• Proximally:– between Pronator Teres and BR
• Distally:
– between FCR and BR
– retract radial artery radially
• Proximally:– between Pronator Teres and BR
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Incision:Begin lateral to biceps tendon and end at
radial styloid
Muscles covering radius:from distal to proximal
• Pronator Quadratus
• FPL
• FDS
• Pronator teres tendon
– can save it from dorsal side, need to cut it or go under it from Henry approach
• Supinator
• Pronator Quadratus
• FPL
• FDS
• Pronator teres tendon
– can save it from dorsal side, need to cut it or go under it from Henry approach
• Supinator
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Thompson approach:
• Incision:– Bovie cord from lateral epicondyle to Lister’s tubercle—draw a line with forearm in neutral
• Incision:– Bovie cord from lateral epicondyle to Lister’s tubercle—draw a line with forearm in neutral
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Interval:
• Between EDC and ECRB– Much easier to find the interval distally
– Put a kelly up under it or use your finger underneath and separate the raphe connecting them as you come proximally
– The muscles separate easily
– Beneath that is the supinator
– Run your finger gently along supinator from proximal to distal and you will feel the PIN
– Gently split the supinator over PIN to identify
• Between EDC and ECRB– Much easier to find the interval distally
– Put a kelly up under it or use your finger underneath and separate the raphe connecting them as you come proximally
– The muscles separate easily
– Beneath that is the supinator
– Run your finger gently along supinator from proximal to distal and you will feel the PIN
– Gently split the supinator over PIN to identify
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Distal to the P.teres insertion:
• Don’t need to find PIN
• Work underneath the APL/EPB—put a penrose around them
• Don’t need to find PIN
• Work underneath the APL/EPB—put a penrose around them
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On radius plates go:
• Straight dorsal
• Straight palmar
• On radial border
• Straight dorsal
• Straight palmar
• On radial border
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Watch out for palmar cutaneous branch of median nerve
• Can cross FCR sheath in subcutaneous tissue or deeper
• Can easily be cut
• Can cross FCR sheath in subcutaneous tissue or deeper
• Can easily be cut
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The End