2/16/2017 ForearmshaftApproachAnteriorapproach(Henry)AOSurgeryReference

Login

ExecutiveEditor:
ChrisColton
Authors:Dominik
Anteriorapproach(Henry)
Heim,ShaiLuria,Rami Introduction
Mosheiff,YoramWeil
Theanterior(Henry)
approachoffersgood
Forearmshaft
exposureofthewhole
Search lengthoftheradius.The
search... lengthoftheincision
dependsontheextentof
Shortcuts exposureneeded.The
AllPreparations Henryapproachintheproximalforearmmightresultina
AllApproaches moreobviousscar.
AllReductions& Thelandmarksfortheskinincisionare:
Fixations 1.Proximally:thebicepstendonwhichcrossesthefront
oftheelbowjoint,medialtothebrachioradialis
muscle.Thedistallandmarkistheradialstyloid
process.
2.Thebrachioradialismuscleispartofthemobilewad,
comprisingthebrachioradialisandtheextensorscarpi
radialisbrevisandlongus.

Thisillustrationshowsthe
extentsoftheincisions
fortheanterior
approachestothe
proximalthird
middlethird
distalthird
oftheradialshaft.
Note:Theposterolateral(Thompson)approachalso
offersgoodaccesstoeitherthemiddleordistalthirdof
theradialshaft.

Superficialdissection
Thesuperficialmusculardissectionissimilarforallthree
partsoftheHenryanteriorapproach,illustratedherefor
theproximalthird.

https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/22/04Approaches/2012/22_A10anteriorHernyappr.jsp&bone=R 1/5
2/16/2017 ForearmshaftApproachAnteriorapproach(Henry)AOSurgeryReference

Developtheinterval
betweenthe
brachioradialis(mobile
wad)andflexorcarpi
radialismuscles.The
radialarteryliesdeepto
thebrachioradialisinthe
middlepartoftheforearm
andbetweenthetendonsofbrachioradialisandflexor
carpiradialisdistally.Itcanbeidentifiedbyitstwo
venaecomitantes,whichrunalongsideit.

Thearterialbranches
arisingfromthelateral
sideoftheradialartery
areidentifiedbyslippinga
fingerunderneaththem,
lateraltotheartery.
Thesearelargelythe
recurrentbranchesand
thosetothemobilewad.
Thesebranchesshouldbeligatedinordertoretractthe
arterymedially.

Thesuperficialradial
nerverunsunderthe
brachioradialismuscleon
thelateralaspectofthe
radialarteryandshould
beretractedlaterally.

Deepdissection:
proximalthird
Thesupinatormuscle
coversthelateralaspect
oftheproximalradius.
Theposterior
interosseousnerve(also
knownasdeepbranchof
theradialnerve)lieswithinthesubstanceofthe
https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/22/04Approaches/2012/22_A10anteriorHernyappr.jsp&bone=R 2/5
2/16/2017 ForearmshaftApproachAnteriorapproach(Henry)AOSurgeryReference

supinatormuscle.Theforearmshouldbefullysupinated
todisplacetheposteriorinterosseousnerveawayfrom
thesurgicalfield.
Thesupinatormuscleisthenincisedalongitsmost
medialedge,andgentlyelevatedfromthebonesurface
onlytotheextentthatitisnecessaryfortherequired
exposure.Theplateisinserteddeeptotheelevated
supinatormuscle.

Note:Makesurethatthe
plateisseatedonthe
bonewithoutanysoft
tissueinterposition.In
rarecases,theposterior
interosseousnerveitself
isidentified.Insuch
casesitisrecommended
thatthepositionofthenerveinrelationshiptotheplate
benotedandlaterdocumentedintheoperationreport.

Deepdissection:
middlethird
Theforearmshouldbe
fullypronatedtoexpose
thelateralborderofthe
pronatorteresmuscleand
itsinsertion.
Note:Sometimesitwill
benecessarytopartiallydetachthepronatorteresfrom
theradius.Wheneverpossible,preserveatleastsomeof
itsinsertion.

Deepdissection:distal
third(classicalHenry
approach)
Pronatingtheforearmwill
exposetheaspectofthe
radiusjustlateraltothe
edgeoftheflexorcarpi
radialis,deeptowhichlie

https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/22/04Approaches/2012/22_A10anteriorHernyappr.jsp&bone=R 3/5
2/16/2017 ForearmshaftApproachAnteriorapproach(Henry)AOSurgeryReference

flexorpollicislongusandthepronatorquadratus,which
becomevisibleiftheforearmisthensupinated.

Theforearmisthenagain
supinatedandthe
exposureoftheboneis
completedbyany
necessaryelevationof
theflexorpollicislongus
and,moredistally,
pronatorquadratus.

Deepdissection:distalthird(modifiedHenry
approach)
Note:whereexposureislikelytobeconfinedtothe
distalradiusonly,thefollowingmodifiedHenryapproach
ispreferredbysomesurgeons.

ThemodifiedHenry
approachutilizesthe
intervalbetweenflexor
carpiradialistendonand
theradialartery,whereas
theclassicalHenry
approachgoesbetween
brachioradialisandthe
radialartery.Themodifiedapproachismedialtothe
radialartery.
Note:Theradialarteryandthepalmarbranchofthe
mediannervearevulnerableduringthisapproach.

Theradialarteryis
retractedlaterallyandthe
flexorcarpiradialisis
retractedinamedial
direction.Thepronator
quadratusmuscleisthen
exposedbyretracting
mediallythemusclebelly
oftheflexorpollicislongus.

https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/22/04Approaches/2012/22_A10anteriorHernyappr.jsp&bone=R 4/5
2/16/2017 ForearmshaftApproachAnteriorapproach(Henry)AOSurgeryReference

Exposureoftheboneis
completedbyincisionof
thelateralanddistal
edgesofpronator
quadratusmuscleleaving
asmalllateralcuffonthe
radiustoallowfor
subsequentrepair.
Thisnowallowselevationofthemusclebellyfromthe
anterioraspectofthedistalradius.

Apartfrompossiblereattachmentofpronatorquadratus,
theanteriordeeptissuesareleftunrepaired.Some
subcutaneoussuturesareinsertedinordertorelieve
tensionontheskinclosure.Wounddrainage,eitherwith
aclosedoranopensystem,isused.Skinclosureis
accomplishedusinginterruptedorrunningsutures,or
skinstaples.

Incertaininstances,for
examplewithmarked
forearmswelling,the
woundmayhavetobe
leftopen.Thereare
differenttechniquesto
overcomesuchdifficulties
(e.g.,elasticclosure,
vacuumassistedclosure,petroleumjellygauze,skin
substitute,etc.)

Tweet

Like 0

v2.020130709

https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/22/04Approaches/2012/22_A10anteriorHernyappr.jsp&bone=R 5/5