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Displaced Radial Shaft Fractures: The Dorsal (Thompson) Approach to the Forearm

March 01, 2020

Contributors: Charlotte N Shields; Kenneth A Egol, MD, FAAOS

Keywords: ORIF

Purpose This video demonstrates repair of a displaced radial shaft fracture via a dorsal (Thompson) approach to the forearm. Methods The patient is an 18-year-old man who sustained a left elbow dislocation and an ipsilateral radial shaft fracture (AO/Orthopaedic Trauma Association type 22-B2) while playing basketball. The patient underwent closed reduction of the elbow joint and was indicated for surgical repair of the radius. Results This video demonstrates management of a left elbow dislocation and radial shaft fracture (AO/Orthopaedic Trauma Association type 22-B2) via open reduction and internal fixation with the use of a compression plate and nonlocking screws and a dorsal (Thompson) approach. Anatomic reduction and stable fixation were achieved via this technique. The posterior interosseous nerve must be identified and protected throughout the procedure. Conclusion A dorsal (Thompson) approach is advantageous for radial shaft fractures that involve the proximal and middle one-third of the radius. This approach is used if soft-tissue damage (open wounds) is present on the dorsal aspect, which requires débridement. In addition, this video shows the technique to identify and protect the posterior interosseous nerve.

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