Review Question - QID 8840

To gain exposure to the proximal radius in a classic volar Henry approach, the radial artery is retracted medially and the supinator muscle should be elevated and retracted laterally with the forearm in supination.

The radial artery runs with the superficial radial nerve deep to the brachioradialis in the proximal radius and is retracted medially in the classic volar Henry approach. Cauterization of branches to the brachioradialis is necessary for mobilization. The supinator muscle overlies the volar proximal radius and is retracted laterally along with the posterior interosseous nerve (PIN). To minimize the risk of neural injury, the forearm in supinated because this displaces the PIN dorsally and away from the plane of dissection. Failure to supinate the forearm and hasty dissection risks PIN injury.

Catalano et al. reviewed surgical exposures of the radius and ulna. The authors discussed the volar and dorsal approaches to the proximal and distal radius as well as the radial shaft, and the approach to the ulnar shaft and distal ulna. They highlight relevant anatomy and potential dangers associated with each approach. The authors stress the importance of forearm supination when elevating the supinator in the proximal exposure of the radial shaft to avoid PIN injury.

Illustrations:
Illustration A demonstrates the exposure to the proximal radial shaft. The forearm is in supination. The supinator is elevated and retracted laterally. The radial artery is retracted medially.
Illustration B demonstrates the relative position of the PIN with forearm pronation and supination. In pronation, the PIN is more volar and lies in line with the plane of dissection, while in supination, the PIN lies more dorsal and away from this plane.

Incorrect Answers:
Answer 1-4: The radial artery is retracted medially and the supinator muscle must be elevated and retracted laterally to gain exposure to the proximal radial shaft. Forearm supination is necessary to minimize the risk of injuring the PIN.