Craniomedial approach to the dog distal radius
1. Indications
An open approach to the distal radius is used for procedures that require exposure of the radial metaphysis and epiphysis.
It is also very helpful for medial plating.
This approach can also be used for an "open-but-do-not-touch" approach, allowing fracture visualization and indirect reduction without removing the fracture hematoma and manipulating the fragments.
2. Anatomy
Key anatomical landmarks to be identified before the surgical approach include:
- Proximally, the radial shaft
- Distally, the medial styloid
When necessary, the abductor pollicis longus can be transected to improve exposure and plate placement.
3. Patient positioning
For this approach, the patient is positioned in one of the following positions:
- Sternal recumbency
- Lateral recumbency with the affected limb down
- Dorsal recumbency
4. Skin incision
A craniomedial skin incision is made from proximal to distal, exposing from the midshaft of the radius to the radiocarpal joint. Depending on the required exposure, the incision can be extended more proximally up to the epicondyle of the humerus.
5. Development
The extensor carpi radialis is retracted laterally and the flexor carpi radialis is retracted caudally.
Distally, the abductor pollicis longus muscle is isolated in order to be medial or lateral during the procedure. The tendon of the extensor carpi radialis is isolated medially and laterally in order to mobilize it from its groove to provide distal exposure.
The cephalic vein is elevated for protection.
When necessary, the abductor pollicis longus can be transected to improve exposure and plate placement.
A dorsal arthrotomy may be necessary for articular fracture repair.
For treatment of intraarticular fractures, the medial collateral ligament should be identified and preserved.
6. Closure
If an arthrotomy has been performed, it should be repaired with sutures. The subcutaneous tissue and skin are closed according to the surgeon's preference.
