The Effect of an Extended Flexor Carpi Radialis Approach on Blood Flow to the Distal Radius: A Cadaveric Study

Abstract

The effect of an extended flexor carpi radialis approach on the blood supply of the radius was examined in six (3 paired) fresh frozen cadaver limbs after injection with India ink and clearing using a modified Spalteholz technique. An extended flexor carpi radialis approach to the distal radius was made in the left limb in each of the three-paired limbs. The right limb served as a nonoperative control. Following perfusion of the arterial vasculatureof each limb with India ink, serial transverse sections were cut and the intraosseous blood supply evaluated using a modified Spalteholz technique. Both controls and surgical specimens demonstrated compíete cortical penetration from endosteal vessels in the proximal and midsectionsof the radius. In the distal radius, surgical specimens demonstrated reduced perfusion volarly, however there continued to be perfusion of ink through intact dorsal and ulnar metaphyseal perforating arteries. Persistent vascular perfusion to the distal radius remains through intact endosteal vessels and metaphyseal perforators of extensive surgical soft-tissue stripping.

Technique, Indications and Limitations of a Minimally Invasive Approach to Treat Distal Radius Fractures and Malunions

“…The promoters of the extended FCR approach use it for fractures with highly displaced articular fragments, for which a proper reduction cannot be obtained through closed maneuvers of reduction. According to the promoters of the extended approach the proximal fragment of the radius benefits from an intra-osseous vascularization that allows sub-periosteal dissection and mobilization without risk of necrosis [3], although some authors have reached opposite conclusions [9]. The extended FCR approach differs from the traditional approach by the release of the distal part of the radial aspect of the antebrachial fascia which enables to mobilize the proximal fragment of the radius into pronation in the same plane as the fracture.…”

Ostéosynthèse mini-invasive par plaque antérieure du radius distal : 710 cas

“…Pour éviter les conflits avec l'appareil fléchisseur, la plaque ne doit pas déborder la watershed line au bord distal du pronator quadratus (PQ). Le PQ est soulevé, exposant la fracture sans [3] ou avec [9] risque de nécrose. Contrairement à l'abord traditionnel, il permet de mobiliser le fragment proximal en pronation et de passer par la fracture, offrant une large exposition [8].…”