Henry's Volar Approach to the Radius

Question 1

Internervous plane

Answer 1

Proximally:
Brachioradialis (RADIAL N. )
Pronator teres (MEDIAN N)

Distally:
Brachioradialis (RADIAL N)
FCR (MEDIAN N)

Question 2

Position / landmarks

Answer 2

pt supine with arm on armboard and arm supinated

Landmarks:
proximally: lateral to biceps tendon
distally radial styloid
incision based over #

Question 3

Superficial dissection

Answer 3

incise fascia inline with skin incision
develop plane between BR + FCR (easier to identify BR distally)
move proximally between BR + PT

BEWARE superficial radial nerve beneath BR

ligate lateral branches or radial artery (Leash of Henry)

Question 4

Deep dissection

Proximal 1/3rd

Answer 4

supinator + PT have perpendicular fibres

fully SUPINATE forearm to move PIN radially and bring insertion of supinator into view.
I start distally and work proximally incising supinator muscle along its insertion subperiosteally

Stay lateral to biceps tendon

Question 5

Deep dissection

Middle 1/3rd

Answer 5

supinator + PT have perpendicular fibres

PRONATE forearm to bring PT insertion into view

detach distally to proximally brings with it origin of FPL

Question 6

Deep dissection

Distal 1/3rd

Answer 6

SUPINATE forearm

dissect periosteum off lateral aspect of distal 1/3rd of radius, lateral to FPL + PQ