153-2012-0258
We are taught by textbooks and residency training to use the craniomedial approach to repair fractures of the radius. We decided to think outside of the box. Reasons we like the caniolateral approach (CLA) versus the caniomedial approach (CMA) for radius fracture repairs:
1. The CLA avoids the cephalic and accessory cephalic vein. During the CMA the cephalic vein commonly needs to be ligated or it is annoyingly in the way.
2. Less stress on shoulder during surgery as the limb does not need to be contorted in an abnormal position for CLA. Patient can be positioned in a lateral position for CLA. Surgeon stands on cranial aspect of the the antebrachium during surgery.
3. Nice flat surface for plate to sit on craniolateral aspect of radius bone for CLA, as is the case for CMA.
4. Relatively tendon free corridor for placement of the plate with CLA. The corridor for the CMA is located beneath the extensor carpi radialis tendon and the plate generally sits under the tendon, therefore there may be some impingement or interference with the tendon.
5. Distal portion of abductor pollicis longus to be transected as needed with both approaches, but may require complete transaction with CMA.
6. The CLA mitigates valgus, as the plate naturally straightens the radius bone. During the CMA, retraction of the extensor carpi radialis has a tendency to create forces that favor valgus of the radius at the level of the fracture.
7. Screws are naturally angled away from the ulna bone with CLA.
8. For long plating of radius fractures the CLA is ideal as the approach continues between the extensor carpi radialis and the common digital extensor muscles. Give the CLA a try the next time you have a radius fracture. Once you get used to it you’ll love it. We have been using this method in clinical cases for about 15 years with great results.
