From the Research
The incision for the volar approach in distal radius fractures is typically made along the lateral aspect of the flexor carpi radialis (FCR) tendon, with a single longitudinal incision of 1.5 cm, as described in the most recent and highest quality study 1. This approach provides optimal access to the volar surface of the distal radius while minimizing the risk of injury to important neurovascular structures. The FCR approach is preferred because it serves as a reliable landmark and creates a safe interval between the radial artery laterally and the median nerve medially. After the skin incision, the surgeon dissects through the fascia overlying the FCR tendon, retracts the tendon ulnarly, and then develops the plane between the flexor pollicis longus and the radial artery to expose the pronator quadratus muscle. The pronator quadratus is then elevated from its radial attachment to expose the fracture site, allowing for reduction and plate fixation of the distal radius fracture.
Some key points to consider when making the incision include:
- The incision should be made on the lateral aspect of the FCR tendon, as described in 2
- The length of the incision can vary, but a single longitudinal incision of 1.5 cm is often sufficient, as described in 2
- The approach should be modified based on the specific fracture pattern and patient anatomy, as described in 3 and 4
- The surgeon should be aware of the potential for anatomical variations, such as the absence of the FCR tendon, as described in 4
Overall, the volar approach for distal radius fractures is a reliable and effective method for treating these injuries, and the incision should be made with careful consideration of the patient's anatomy and the specific fracture pattern, as supported by the evidence from 5, 2, and 1.