Vol 70, No 3 (2011)
Original article
Published online: 2011-08-24
Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet
Folia Morphol 2011;70(3):204-210.
Abstract
The Henry approach is the classical anterolateral surgical exposure of the volar
aspect of the distal radius. This approach does not allow good access to the medial
side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it
is extended proximally, retracting the tendons and the median nerve medially,
which can cause some trauma. The purpose of our study was to investigate the
anatomic basis and to outline the advantages of the unusual anteromedial approach,
reporting our experience in the treatment of 4 distal radius fractures, with
a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The
average follow-up was 68.8 months (range 18 to 115 months). In our series, this
approach did not cause any nerve injuries or any sensory loss of the distal forearm
and the palm. All the fractures of the lunate facet and of the radial styloid process
healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis,
but with no instability of the distal radio-ulnar joint or pain on the ulnar
side. Using the criteria of Green and O’Brien, modified by Cooney, the results
were: excellent in two cases, good in one case, and average in another. The evaluation
of arthritis according to Knirk and Jupiter’s classification showed grade 0 in
three cases and grade 3 in one case with osteochondral sclerosis. We showed that
the anteromedial approach is reliable and convenient in the case of fractures situated
in the antero-medial portion of the radius, for the double objective of reducing
the fracture under direct control and checking the congruence of the distal
radio-ulnar joint. (Folia Morphol 2011; 70, 3: 204–210)
Keywords: articular fracturedistal radio-ulnar jointligamentous