Applied surgical anatomy of forearm
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Applied surgical anatomy of forearm

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Applied surgical anatomy of forearm Presentation Transcript

  • 1. ANTERIOR APPROACHANTERIOR APPROACH TO RADIUS AND ITSTO RADIUS AND ITS APPLIED ANATOMYAPPLIED ANATOMY
  • 2. INDICATIONS AND POSITIONINDICATIONS AND POSITION  ORIF of fracturesORIF of fractures  Bone grafting and fixation of nonunion of radiusBone grafting and fixation of nonunion of radius  Radial osteotomyRadial osteotomy  Biopsy of tumorsBiopsy of tumors  Excision of sequestra of chronic osteomyelitisExcision of sequestra of chronic osteomyelitis  Exposure of bicipital tuberosityExposure of bicipital tuberosity  POSITION – supine , the arm on the arm boardPOSITION – supine , the arm on the arm board supinated with tourniquet.supinated with tourniquet.
  • 3.  LANDMARK AND INCISION:LANDMARK AND INCISION: the biceps tendonthe biceps tendon which crosses the elbow joint medially to thewhich crosses the elbow joint medially to the brachioradialis muscle. The distal end of the incision isbrachioradialis muscle. The distal end of the incision is the radial styloid process.the radial styloid process.
  • 4.  Inter-nervous planeInter-nervous plane  Superficial radial nerveSuperficial radial nerve  Radial arteryRadial artery
  • 5. Proximal third dissectionProximal third dissection
  • 6. MIDDLE THIRD DISSECTIONMIDDLE THIRD DISSECTION
  • 7. DISTAL THIRD DISSECTIONDISTAL THIRD DISSECTION
  • 8. ANTERIOR COMPARTMENTANTERIOR COMPARTMENT  Mobile wad to 3 muscles brachioradialis,Mobile wad to 3 muscles brachioradialis, extensor carpi radialis longus and brevisextensor carpi radialis longus and brevis  Flexor-pronator group 3 layersFlexor-pronator group 3 layers  Inter-nervous planes:-Inter-nervous planes:- 1. B/W brachioradialis and FCR/ pronator teres1. B/W brachioradialis and FCR/ pronator teres for anterior approach to radiusfor anterior approach to radius 2. B/W FCU and FDS for ulnar nerve2. B/W FCU and FDS for ulnar nerve 3. B/W FCU and ECU for ulna3. B/W FCU and ECU for ulna
  • 9.  Brachioradialis action responsible for neutralBrachioradialis action responsible for neutral positionposition  Recovering high radial nerve palsy is assessedRecovering high radial nerve palsy is assessed by testing brachioradialisby testing brachioradialis  Radial arteryRadial artery  Superficial branch of radial nerve – sensory lossSuperficial branch of radial nerve – sensory loss painful neuroma.painful neuroma.
  • 10. DEEP DISSECTIONDEEP DISSECTION  Arcade of frohse in the substance of theArcade of frohse in the substance of the supinator musclesupinator muscle  Post interosseous nerve syndromePost interosseous nerve syndrome  Resistant tennis elbowResistant tennis elbow  Pronator syndrome – mimics carpal tunnelPronator syndrome – mimics carpal tunnel syndrome but the muscles supplied by the antsyndrome but the muscles supplied by the ant interosseous nerve are spared.interosseous nerve are spared.  FDS, FPL, pronator quadratusFDS, FPL, pronator quadratus
  • 11. POST INTEROSSEOUS NERVEPOST INTEROSSEOUS NERVE  Passes B/W the heads of the supinator muslePasses B/W the heads of the supinator musle  Sometimes it may come in direct contact withSometimes it may come in direct contact with the periosteum of the neck of radiusthe periosteum of the neck of radius  Supplies the extensor compartmentSupplies the extensor compartment  Insertion of supinator is detachedInsertion of supinator is detached subperiosteally along with the nerve in thesubperiosteally along with the nerve in the substance of the musclesubstance of the muscle  Posterior approach is safest for PINPosterior approach is safest for PIN  Median nerve close proximity FDSMedian nerve close proximity FDS
  • 12. POST INTEROSSEOUS NERVEPOST INTEROSSEOUS NERVE SYNDROMESYNDROME
  • 13. HENRY’S VOLAR AND DORSALHENRY’S VOLAR AND DORSAL FACIOTOMYFACIOTOMY