Master Tech Ortho Surgery Elbow CH1
1 Exposures of the Upper Extremity: Humerus, Elbow, Forearm
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CHAPTER 1C: THE FOREARM Clinically, there are only three relevant exposures of the forearm. These expose the radius from a posterior (Thompson) and from an anterior (Henry) perspective and the ulna from a dorsal perspec- tive. All three are readily extended depending on the pathology being treated. POSTERIOR APPROACH TO THE RADIUS (THOMPSON) Indications Fracture, tumor, and infection when access to posterior radius desired. Note: This approach is not commonly employed but may be used to expose the proximal, mid-, or distal radius but is most effective for the proximal and middle thirds. Position The patient is supine with arm across the chest or on arm/elbow table. Landmarks Lateral epicondyle to radial styloid. Skin Incision ●● Straight from the lateral epicondyle to the radial styloid. With the forearm pronated, the line of the incision is a straight line. Use all or any portion (Fig. 1C-1).
Technique ●● Expose the interval between the anterior border of the extensor digitorum communis and the posterior or radial border of the extensor carpi radialis brevis. ●● Distally palpate the bare portion of the radius that superficially demarcates the natural interval between these two muscle groups (Fig. 1C-2). Deep to these muscles, the bare area identifies the distal aspect of the supinator and proximal attachment of the pronator teres tendon. ●● The forearm fascia is split proximally and distally allowing the extensor digitorum communis to be retracted posteriorly and extensor carpi radialis brevis to be retracted anteriorly to the ulnar
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