In general, there are two palmar surgical approaches to the distal radius – a modified Henry approach to the radius and a more ulnar approach, designed to expose the median nerve as well as the distal radius.
The modified Henry approach is suitable for most fractures of the distal radius.
If it is desired to decompress the carpal tunnel, this may be performed either through one ulnar extensile approach or two separate approaches.
An ulnar palmar approach facilitates exposure of the sigmoid notch, the lunate facet, the palmar wrist capsule, the distal radioulnar joint and distal ulna. It is less suitable for the radial part of the distal radius.
For high energy fractures an extended ulnar approach may be used.
2. Ulnar Palmar approach - Introduction
The ulnar palmar approach uses the plane between the ulnar artery and nerve on one side and the flexor tendons on the other side.
3. Skin Incision
The incision starts at the wrist crease, and runs proximally parallel to the ulna. It can be extended along the wrist crease and distally into the palm.
The interval is developed between the ulnar artery and nerve on one side and flexor tendons on the other side.
The flexor tendons and median nerve are retracted towards the radius to provide excellent exposure of the pronator quadratus.
The pronator quadratus is incised as much as necessary.
Expose the ulnar side of the distal radius by elevating the incised portion of the pronator quadratus.
5. Extension of ulnar palmar approach
The ulnar palmar approach may be extended distally. This allows decompression of the carpal tunnel and gives good access to the radiocarpal structures in high energy injures.