Applied surgical anatomy of forearm
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Transcript of Applied surgical anatomy of forearm
ANTERIOR APPROACH ANTERIOR APPROACH TO RADIUS AND ITS TO RADIUS AND ITS APPLIED ANATOMYAPPLIED ANATOMY
INDICATIONS AND POSITIONINDICATIONS AND POSITION
ORIF of fracturesORIF of fractures Bone grafting and fixation of nonunion of radiusBone grafting and fixation of nonunion of radius Radial osteotomyRadial osteotomy Biopsy of tumorsBiopsy of tumors Excision of sequestra of chronic osteomyelitisExcision of sequestra of chronic osteomyelitis Exposure of bicipital tuberosityExposure of bicipital tuberosity
POSITION – supine , the arm on the arm board POSITION – supine , the arm on the arm board supinated with tourniquet.supinated with tourniquet.
LANDMARK AND INCISION: LANDMARK AND INCISION: the biceps tendon the biceps tendon which crosses the elbow joint medially to the which crosses the elbow joint medially to the brachioradialis muscle. The distal end of the incision is brachioradialis muscle. The distal end of the incision is the radial styloid process. the radial styloid process.
Inter-nervous plane Inter-nervous plane Superficial radial nerve Superficial radial nerve Radial arteryRadial artery
ANTERIOR COMPARTMENTANTERIOR COMPARTMENT
Mobile wad to 3 muscles brachioradialis, Mobile wad to 3 muscles brachioradialis, extensor carpi radialis longus and brevisextensor carpi radialis longus and brevis
Flexor-pronator group 3 layersFlexor-pronator group 3 layers Inter-nervous planes:-Inter-nervous planes:-
1. B/W brachioradialis and FCR/ pronator 1. B/W brachioradialis and FCR/ pronator teresteres
for anterior approach to radiusfor anterior approach to radius
2. B/W FCU and FDS for ulnar nerve2. B/W FCU and FDS for ulnar nerve
3. B/W FCU and ECU for ulna3. B/W FCU and ECU for ulna
Brachioradialis action responsible for Brachioradialis action responsible for neutral positionneutral position
Recovering high radial nerve palsy is Recovering high radial nerve palsy is assessed by testing brachioradialisassessed by testing brachioradialis
Radial arteryRadial artery Superficial branch of radial nerve – Superficial branch of radial nerve –
sensory losssensory loss
painful neuroma.painful neuroma.
DEEP DISSECTIONDEEP DISSECTION Arcade of frohse in the substance of the Arcade of frohse in the substance of the
supinator musclesupinator muscle Post interosseous nerve syndromePost interosseous nerve syndrome Resistant tennis elbowResistant tennis elbow Pronator syndrome – mimics carpal tunnel Pronator syndrome – mimics carpal tunnel
syndrome but the muscles supplied by the syndrome but the muscles supplied by the ant interosseous nerve are spared.ant interosseous nerve are spared.
FDS, FPL, pronator quadratusFDS, FPL, pronator quadratus
POST INTEROSSEOUS NERVEPOST INTEROSSEOUS NERVE
Passes B/W the heads of the supinator Passes B/W the heads of the supinator muslemusle
Sometimes it may come in direct contact Sometimes it may come in direct contact with the periosteum of the neck of radiuswith the periosteum of the neck of radius
Supplies the extensor compartmentSupplies the extensor compartment Insertion of supinator is detached Insertion of supinator is detached
subperiosteally along with the nerve in the subperiosteally along with the nerve in the substance of the musclesubstance of the muscle
Posterior approach is safest for PINPosterior approach is safest for PIN Median nerve close proximity FDSMedian nerve close proximity FDS