Extended Flexor Carpi Radialis Approach

Abstract

Summary:The extended flexor carpi radialis (FCR) approach is a useful, extensile surgical exposure that can be used in the treatment of distal radius fractures. It allows for reduction of partially healed, complex articular fractures and those fractures involving the volar rim of the ulnar fossa. It expands the traditional Henry approach by providing more distal exposure and access to the dorsal aspect of the radius. The extended FCR approach is performed in four steps: (1) The FCR tendon sheath is released distally to the tuberosity of the trapezium, (2) the radial septum including the brachioradialis insertion and the first dorsal extensor compartment is released, (3) the volar surface of the radius is exposed by elevating the transitional fibrous zone and the pronator quadratus, (4) and finally, the proximal fragment is pronated through the fracture site exposing the dorsal aspect of the distal radius. This intrafocal exposure allows debridement of the fracture by removing organized hematoma or callus to allow anatomical reduction of the fracture.Level of Evidence:Level V - Expert Opinion.