Henry Versus Thompson Approach for Fixation of Proximal Third Radial Shaft Fractures: A Multicenter Study

Abstract

Objective: To compare the volar Henry and dorsal Thompson approaches with respect to outcomes and complications for proximal third radial shaft fractures. Design: Multicenter retrospective cohort study. Patients/Participants: Patients with proximal third radial shaft fractures ± associated ulna fractures (OTA/AO 2R1 ± 2U1) treated operatively at 11 trauma centers were included. Intervention: Patient demographics and injury, fracture, and surgical data were recorded. Final range of motion and complications of infection, neurologic injury, compartment syndrome, and malunion/nonunion were compared for volar versus dorsal approaches. Main Outcome: The main outcome was difference in complications between patients treated with volar versus dorsal approach. Results: At an average follow-up of 292 days, 202 patients (range, 18–84 years) with proximal third radial shaft fractures were followed through union or nonunion. One hundred fifty-five patients were fixed via volar and 47 via dorsal approach. Patients treated via dorsal approach had fractures that were on average 16 mm more proximal than those approached volarly, which did not translate to more screw fixation proximal to the fracture. Complications occurred in 11% of volar and 21% of dorsal approaches with no statistical difference. Conclusions: There was no statistical difference in complication rates between volar and dorsal approaches. Specifically, fixation to the level of the tuberosity is safely accomplished via the volar approach. This series demonstrates the safety of the volar Henry approach for proximal third radial shaft fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Volar versus dorsal surgical approaches in fractures of proximal radius in adults: A prospective randomized controlled trial

“…As a period of 6 to 9 months may be required to observe recovery even in PIN neurapraxias 13 , the duration of our study was inadequate and all three patients had PIN palsies during the last follow-up at 6 months. In a multicenter study by Dashe J et al 14 , there were only three neurologic injuries in the series; two in the volar and one in the dorsal group. Nasab SAM et al 19 observed that radial nerve injury had occurred in three patients in the volar group (injury to superficial radial nerve in one and injury to PIN in two) and in two patients in the dorsal group (injury to PIN in both).…”

“…This was consistent with the study performed by Cross et al 18 where the two approaches did not result in a significant difference in the area exposed. Dashe J et al 14 observed that patients treated with a dorsal approach had fractures that were slightly more proximal (p-value 0.0006). Still, this did not translate to more fixation proximal to the fracture, indicating no difference in exposures for satisfactory fixation in either approach 14 In all the three cases with PIN palsies, the proximal radius had been exposed by subperiosteal elevation of the supinator without direct visualization of the PIN, and the plates had not been placed proximally up to the radial neck, ruling out entrapment of the nerve under the plate.…”

“…Dashe J et al 14 observed that patients treated with a dorsal approach had fractures that were slightly more proximal (p-value 0.0006). Still, this did not translate to more fixation proximal to the fracture, indicating no difference in exposures for satisfactory fixation in either approach 14 In all the three cases with PIN palsies, the proximal radius had been exposed by subperiosteal elevation of the supinator without direct visualization of the PIN, and the plates had not been placed proximally up to the radial neck, ruling out entrapment of the nerve under the plate. As a period of 6 to 9 months may be required to observe recovery even in PIN neurapraxias 13 , the duration of our study was inadequate and all three patients had PIN palsies during the last follow-up at 6 months.…”

“…When the nerve lies posteriorly juxtaposed to the radial neck, which occurs in a quarter of the population, retractor placement can compress it against the bone 13 . Nonetheless, fixation to the level of the tuberosity can be safely accomplished without an increase in risk to the PIN 14 .…”

“…Some studies have concluded that there is no significant difference in the functional outcome of the two approaches 14,18,19 . Similarly, some studies have given preference to the volar approach 16,[20][21][22][23] and others, the dorsal approach 11,24 .…”