4 Palmar Fracture/Subluxation of the Distal Radius

• Palmar approach via zigzag incision over flexor carpi radialis (FCR) sheath. (Fig. 4-1)

Pitfall

Don’t stray radial to the FCR in superficial dissection, which will risk injury to the palmar cutaneous branch of the median nerve.

• Retract FCR radially.
  
• Incise floor of FCR sheath.
  
• Elevate pronator quadratus off of radius by subperiosteal dissection working from radial to ulnar (Fig. 4-2A).
  
• Elevate the brachioradialis off the radial styloid.
  
• Debride fracture site, elevate palmar cortical fragments to access and reduce impacted articular surface (Fig. 4-2B).

Figure 4-1

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