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Introduction Fractures of the distal radius are among the most common fractures seen [, ]. As our population ages, the prevalence of these injuries is expected to increase. Similarly, over the past several years, we have observed a dramatic increase in the surgical management of distal radius fractures []. This increase in surgical intervention can be attributed to the development of new plating systems and the potential clinical benefits of more precise fracture reduction and early mobilization [, ]. Surgical implants for the management of distal radius fractures have also dramatically grown in number and include dorsal plates, volar plates, radial plates, fragment-specific fixation, and intramedullary nails [–] (see Fig. ). Each implant can offer different advantages in the management of distal radius fractures. In order to obtain the best fracture reduction, various surgical approaches may be required.

This article will review the regional anatomy of the distal radius and the various relevant surgical approaches. Hp Clj 4700 Firmware Update. Anatomy Exposure of the distal radius and its fracture fragments is complicated by the close proximity of surrounding muscle, ligaments, tendons, and neurovascular structures. The individual alignment of various articular fracture fragments of the distal radius is affected by these soft tissue attachments []. When studying the distal radius, it is helpful to consider its five “surfaces”: (1) the volar surface, (2) the radial surface, (3) the dorsal surface, (4) the distal radiocarpal articular surface, and (5) the distal radioulnar articular surface (see Fig. ). Understanding the anatomy and position of each surface is important for adequate exposure and subsequent reduction in the management of distal radius fractures.

Altera University Program Qsimia. Superficial Anatomy The surface and superficial anatomy about the distal radius includes a soft tissue envelope that enjoys a rich blood supply and dense cutaneous innervation. Incisions can be placed liberally as long as the principles of maintaining longitudinal or oblique incisions are honored, underlying cutaneous nerves protected, and subcutaneous veins preserved whenever feasible. Branches of the radial sensory nerve reside in the subcutaneous tissue over the radial surface and provide sensation to the radial aspect of the wrist and the first web space dorsally. The radial sensory nerve emerges from below the brachioradialis tendon approximately 8–9 cm proximal to the radial styloid and on average divides into four branches [, ]. The dorsal cutaneous branch of the ulnar nerve provides sensation to the ulnar aspect of the wrist. It arises approximately 3–5 cm proximal to the ulnar styloid, and it typically crosses volar to the head of the ulna before traveling dorsally to the ulnar hand []. Although there is much variability as to when the dorsal cutaneous branch of the ulnar nerve branches, there is little variability in the branching pattern with most branches traveling dorsally and the remaining traveling volarly over the hypothenar eminence [].

In addition, the dorsal aspect of the hand is also supplied by a consistent contribution from the lateral and posterior antebrachial cutaneous nerves []. In a detailed study of the dorsal innervations of the hand, Mok et al. Noted that the dorsal hand and wrist were equally divided and innervated the sensory branch of the radial nerve and dorsal ulnar sensory branch of the ulnar nerve []. The palmar cutaneous branch of the median nerve provides sensation to the volar wrist and palm of the hand. It arises approximately 3.2 cm proximal to the wrist crease from the radial side of the median nerve and typically runs along the radial border of the palmaris longus tendon []. At the level of the wrist crease, the nerve travels approximately 5 mm radial to the inter-thenar depression []. Deep Anatomy Excluding the two articular surfaces, the remaining three surfaces of the distal radius are covered almost entirely by soft tissue.