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Exposure of Proximal Third of Radius through Anterolateral Incision

- See:
       - Anterior Approach to Radial Shaft:
       - @<c:ovvuimgp -s c:osdiagfor.1[Diagram
       - Plating Techniques:

- Discussion:
    - incision begins distal to flexor crease of elbow & extends distally for approx
         15 cm along the anterior border of brachioradialis;
          - brachioradialis is retracted laterally - avoid injury to superficial branch of radial nerve which lies beneath;
    - pronator teres & FCR form medial wall of incision;
    - radial artery is indentified as it is retracted medially;
    - follow biceps to its insertion into bicipital tuberosity of radius;
         - laterally gain access to the adjacent bursa which allows exposure of proximal part of shaft of the radius;
         - deepen wound on the lateral side of the biceps tendon inorder to avoid radial artery which lies superficial & medial to the tendon at this point,
    - Identification of Posterior Interosseous Nerve:
         - posterior interosseous nerve is most vulnerable w/ this approach;
         - need to identify the nerve by first identifying supinator; through which PIN passes on its way to posterior compartment of forearm;
         - proximally, fibers of supinator are identified as are fibers of pronator teres which will be seen more distally passing over supinator in opposite direction;
               - effort is to preserve insertion of pronator teres, but it can be detected and replaced if necessary;
         - in order to displace nerve posterolaterally (away from surgical area), supinate forearm, & expose the insertion of supinator muscle into anterior aspect of radius
         - incision is made into periosteum along line of junction of supinator & pronator teres, & bone is exposed by subperiosteal dissection;
                - subperiosteally dissect supinator muscle along line of its broad insertion
         - continue dissection laterally, stripping muscle off bone;
         - lateral retraction of supinator lifts the PIN aways from operative field