Single-Incision Extensile Volar Approach to the Distal Radius and Concurrent Carpal Tunnel Release: Cadaveric Study

Pensy, Raymond A.; Brunton, Lance M.; Parks, Brent G.; Higgins, James P.; Chhabra, Arvind

doi:10.1016/j.jhsa.2009.11.011

Cited by 27 publications

(24 citation statements)

References 24 publications

(25 reference statements)

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“…Similarly, identification and protection of the branches can avoid inadvertent traction or injury. Alternatively, the carpal tunnel can be released through the same incision utilizing distal identification and release of the transverse carpal ligament [33]. The release requires retraction of the FCR tendon from its opened sheath superficially and radially revealing the superficial aspect of the transverse carpal ligament for release.…”

Section: The Henry and Trans-fcr Approachmentioning

confidence: 99%

“…The release requires retraction of the FCR tendon from its opened sheath superficially and radially revealing the superficial aspect of the transverse carpal ligament for release. Next, the superficial aspect, the FPL tendon is retracted ulnarly revealing the deep slip of the transverse carpal ligament for subsequent release [33].…”

Section: The Henry and Trans-fcr Approachmentioning

confidence: 99%

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Surgical Approaches to the Distal Radius

Ilyas

2010

Hand (New York, N,Y.)

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Section: The Henry and Trans-fcr Approachmentioning

confidence: 99%

Section: The Henry and Trans-fcr Approachmentioning

confidence: 99%

Surgical Approaches to the Distal Radius

Ilyas

2010

Hand (New York, N,Y.)

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“…5,6,20,21) The palmar cutaneous branch of the median nerve lies close to the FCR sheath and various anatomical variations in its origin and course render it vulnerable to injury during surgical approaches in this area. 5,10,11,13,14,[22][23][24][25] The most common manifestations of a PCBMN injury in our series were parasthesiae, hypoaesthesia or anaesthesia in the distribution of the nerve coupled with pain on extension of the wrist. Two patients with numbness as the predominant symptom improved without surgery.…”

Section: )mentioning

confidence: 64%

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Samson

Power

2017

J Hand Surg Asian-Pac Vol

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Background: Our aims were to identify iatrogenous injuries to the palmar branch of the median nerve sustained during volar plate fixation of the distal radius, make the clinician aware of this relatively uncommon complication of distal radius fixation, to emphasise common threads in symptomatology and to propose an algorithm for evaluation and management. Methods: Retrospectively interrogating our database over a 5 year period, the case records, neurophysiology records, operative records, therapy records were reviewed. The data was analysed with regard to the grade of surgeon performing the procedure, the site of injury, complexity of the fracture, delay to surgery, implant choice and outcome of the treatment. Variations in nerve anatomy were documented during revision surgery and common themes in symptomatology and clinical presentation were identified. Results: Seven patients with an iatrogenic injury involving the palmar branch of the median nerve associated with volar plate fixation of the distal radius were assessed. The male: female ratio was 1:6 and the mean age of patients was 47.8 years (33-74 years). The initial operative fixation was undertaken by a consultant orthopaedic surgeon at a mean of 7.8 (1-17) days from injury. The mean time from fracture fixation surgery to referral to the peripheral nerve injury service was 8.9 (2-36) months. Six patients presented with pain on attempted wrist extension. Five patients had parasthesia, hyperaesthesia or dysaesthesia in the distribution of the PCBMN. Anaesthesia or hypoaesthesia was present in three patients. Two patients presented with symptoms of complex regional pain syndrome (CRPS) Type 2. Conclusions: Revising relevant anatomy and possible variations as well as careful placements of retractors in the region of the median nerve could bring down these injuries. We propose an algorithm for their management.

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“…3A, 3B). Digital palpation confirms complete division of the TCL from its radial attachment 23 (Fig. 4).…”

Section: Surgical Techniquementioning

confidence: 77%

“…A recent cadaveric study demonstrated the effectiveness of decreasing pressure in the carpal tunnel when this approach is used in conjunction with volar plating of the distal radius. 23 This FCR CTR 22 using a hybrid FCR approach 13 has been performed at our institution since 2003. We have routinely used this approach for concurrent distal radius fracture fixation and median nerve decompression, regardless of the absence or presence of preoperative median nerve dysfunction.…”

mentioning

confidence: 99%