The Cadaveric Anatomy of the Distal Radius: Implications for the Use of Volar Plates

Overview

Journal Ann R Coll Surg Engl

Specialty General Surgery

Date 2012 Mar 7

PMID 22391383

Citations 8

Authors

P A McCann

D Clarke

R Amirfeyz

R Bhatia

Affiliations

Soon will be listed here.

Abstract

Introduction: Fractures of the distal radius are common upper limb injuries, representing a substantial proportion of the trauma workload in orthopaedic units. With ever increasing advancements in implant technology, operative intervention is becoming more frequent. As growing numbers of surgeons are performing operative fixation of distal radial fractures, an accurate understanding of the relevant surgical anatomy is paramount. The flexor carpi radialis (FCR) tendon forms the cornerstone of the Henry approach to the volar cortex of the distal radius. A number of key neurovascular structures around the wrist are potentially at risk during this approach, especially when the FCR is mobilised and placed under retractors.

Methods: In order to clarify the safe margins of the FCR approach, ten fresh frozen human cadaver limbs were dissected. The location of the radial artery, the median nerve, the palmar cutaneous branch of the median nerve and the superficial branch nerve were measured with respect to the FCR tendon. Measurements were taken on a centre-to-centre basis in the coronal plane at the watershed level. In addition, the distances between the tendons of brachioradialis, abductor pollicis longus and flexor pollicis longus, and the radial artery and median nerve were measured to create a complete picture of the anatomy of the FCR approach to the distal radius.

Results: The structure most at risk was the palmar cutaneous branch of the median nerve. It was located on average 3.4mm from the FCR tendon. The radial artery and the main trunk of the median nerve were located 7.8mm and 8.9mm from the tendon. The superficial branch of the radial nerve was 24.4mm from the FCR tendon and 11.1mm from the brachioradialis tendon.

Conclusions: Operative intervention is not without complication. We believe a more accurate understanding of the surgical anatomy is key to the prevention of neurovascular damage arising from the surgical management of distal radial fractures.

Citing Articles

Osteometric Study of the Dorsal (Lister's) Tubercle of the Radius in Relation to the Neighboring Anatomical Elements: Suprastyloid, Accessory, and Oblique Crests.

Grigorita L, Barbulescu C, Varga N, Grigorita A, Vaida M, Stana L Life (Basel). 2025; 15(2).

PMID: 40003681 PMC: 11857356. DOI: 10.3390/life15020273.

Analysis of Three-Dimensional Anatomical Variance and Fit of the Distal Radius to Current Volar Locking Plate Designs.

Perrin M, Badre A, Suh N, Lalone E J Hand Surg Glob Online. 2022; 2(5):277-285.

PMID: 35415516 PMC: 8991631. DOI: 10.1016/j.jhsg.2020.07.003.

Interpretations of the Term "Watershed Line" Used as Reference for Volar Plating.

Bergsma M, Doornberg J, Hendrickx L, Hayat B, Kerkhoffs G, Jhadav B J Wrist Surg. 2020; 9(3):268-274.

PMID: 32509435 PMC: 7263865. DOI: 10.1055/s-0039-1694719.

A retrospective comparison of clinical and radiological outcomes using palmar or dorsal plating to treat complex intraarticular distal radius fractures (AO 2R3 C3).

Child C, Muller A, Allemann F, Pape H, Welter J, Breiding P Eur J Trauma Emerg Surg. 2020; 48(6):4357-4364.

PMID: 32415367 DOI: 10.1007/s00068-020-01389-y.

The Watershed Line of the Distal Radius: Cadaveric and Imaging Study of Anatomical Landmarks.

Bergsma M, Doornberg J, Borghorst A, Kernkamp W, Jaarsma R, Bain G J Wrist Surg. 2020; 9(1):44-51.

PMID: 32025354 PMC: 7000252. DOI: 10.1055/s-0039-1698452.

References

Dasilva M, Moore D, Weiss A, Akelman E, Sikirica M . Anatomy of the palmar cutaneous branch of the median nerve: clinical significance. J Hand Surg Am. 1996; 21(4):639-43. DOI: 10.1016/S0363-5023(96)80018-9. View

Leung F, Zhu L, Ho H, Lu W, Chow S . Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model. J Hand Surg Br. 2003; 28(3):263-6. DOI: 10.1016/s0266-7681(03)00011-1. View

Valbuena S, Cogswell L, Baraziol R, Valenti P . Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir Main. 2010; 29(2):109-13. DOI: 10.1016/j.main.2009.12.005. View

Bederman S, Anastakis D . Giant arteriovenous fistula of the upper extremity after distal radius fracture: a rare complication after a common problem. J Trauma. 2007; 63(2):E30-3. DOI: 10.1097/01.ta.0000246198.10350.98. View

Hattori Y, Doi K, Sakamoto S, Yukata K . Delayed rupture of extensor digitorum communis tendon following volar plating of distal radius fracture. Hand Surg. 2009; 13(3):183-5. DOI: 10.1142/S0218810408004055. View

Buzzell J, Weikert D, Watson J, Lee D . Precontoured fixed-angle volar distal radius plates: a comparison of anatomic fit. J Hand Surg Am. 2008; 33(7):1144-52. DOI: 10.1016/j.jhsa.2008.02.029. View

Dos Remedios C, Nebout J, Benlarbi H, Caremier E, Sam-Wing J, Beya R . [Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique]. Chir Main. 2009; 28(4):224-9. DOI: 10.1016/j.main.2009.04.007. View

Monda M, Ellis A, Karmani S . Late rupture of flexor pollicis longus tendon 10 years after volar buttress plate fixation of a distal radius fracture: a case report. Acta Orthop Belg. 2010; 76(4):549-51. View

Orbay J, Badia A, Indriago I, Infante A, Khouri R, Gonzalez E . The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg. 2006; 5(4):204-11. DOI: 10.1097/00130911-200112000-00004. View

10.

Lee H, Wong Y, Chan B, Low C . Fixation of distal radius fractures using AO titanium volar distal radius plate. Hand Surg. 2003; 8(1):7-15. DOI: 10.1142/s0218810403001339. View

11.

McCann P, Amirfeyz R, Wakeley C, Bhatia R . The volar anatomy of the distal radius--an MRI study of the FCR approach. Injury. 2010; 41(10):1012-4. DOI: 10.1016/j.injury.2010.02.031. View

12.

Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M . Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007; 21(5):316-22. DOI: 10.1097/BOT.0b013e318059b993. View

13.

Perry D, Machin D, Casaletto J, Brown D . Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study. Ann R Coll Surg Engl. 2010; 93(1):57-60. PMC: 3293274. DOI: 10.1308/003588411X12851639107151. View

14.

Wright T, Horodyski M, Smith D . Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005; 30(2):289-99. DOI: 10.1016/j.jhsa.2004.11.014. View

15.

Matloub H, Yan J, Mink van der Molen A, Zhang L, Sanger J . The detailed anatomy of the palmar cutaneous nerves and its clinical implications. J Hand Surg Br. 1998; 23(3):373-9. DOI: 10.1016/s0266-7681(98)80061-2. View

16.

Pirela-Cruz M, Scher D . Exposure of distal radius fractures using a direct radial approach with mobilization of the superficial branch of the radial nerve. Tech Hand Up Extrem Surg. 2010; 14(4):218-21. DOI: 10.1097/BTH.0b013e3181e1d2d5. View

17.

Orbay J, Fernandez D . Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004; 29(1):96-102. DOI: 10.1016/j.jhsa.2003.09.015. View

18.

Orbay J . Volar plate fixation of distal radius fractures. Hand Clin. 2005; 21(3):347-54. DOI: 10.1016/j.hcl.2005.02.003. View

19.

Levin S, Nelson C, Botts J, Teplitz G, Kwon Y, Serra-Hsu F . Biomechanical evaluation of volar locking plates for distal radius fractures. Hand (N Y). 2008; 3(1):55-60. PMC: 2528971. DOI: 10.1007/s11552-007-9063-1. View

20.

Berglund L, Messer T . Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg. 2009; 17(6):369-77. DOI: 10.5435/00124635-200906000-00005. View