open access

Vol 70, No 3 (2011)
ORIGINAL ARTICLES
Published online: 2011-08-24
Submitted: 2012-06-27
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Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet

A.-P. Uzel, A. Bulla, M. Laurent-Joye, P. Caix
Folia Morphol 2011;70(3):204-210.

open access

Vol 70, No 3 (2011)
ORIGINAL ARTICLES
Published online: 2011-08-24
Submitted: 2012-06-27

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)

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)
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Keywords

articular fracture; distal radio-ulnar joint; ligamentous

About this article
Title

Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet

Journal

Folia Morphologica

Issue

Vol 70, No 3 (2011)

Pages

204-210

Published online

2011-08-24

Bibliographic record

Folia Morphol 2011;70(3):204-210.

Keywords

articular fracture
distal radio-ulnar joint
ligamentous

Authors

A.-P. Uzel
A. Bulla
M. Laurent-Joye
P. Caix

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