Early Complications Associated with the Thompson Approach to the Proximal Radius

The purpose of this study was to investigate the early complications associated with the dorsal approach to the proximal radius. This approach, also called the Thompson approach, is used relatively infrequently for the treatment of forearm fractures. It is primarily reserved for proximal one-third radius fractures where a volar plate may not be placed sufficiently proximal for adequate fixation.

A retrospective chart review was performed on forearm fractures performed at our institution. Over a period from January 2008 to May 2014 a total of 120 patients underwent fixation for radius shaft fractures either isolated or associated with ulna fractures; of these 120 patients, 11 were found to have utilized the Thompson approach to the proximal radius. Demographic data was collected, along with fracture pattern, and associated complications in the first 2 weeks after surgery.

The average age of the patients was 31 years (range: 20 to 46 years). Ten patients were male and one was female. The mean follow-up time was 15 weeks (range: 1 to 52 weeks). The stated indication for the dorsal approach was a proximal location of the radius fracture in 10 cases and presence of dorsal open wounds in one patient. In all cases, the posterior interosseous nerve was identified and protected. The average distance from the fracture to the radial head articular surface was 72 mm (range: 34 mm to 132 mm). Four fractures were open, and seven were closed injuries. There were two postoperative posterior interosseous nerve palsies, along with one compartment syndrome requiring fasciotomy. There were no wound complications. There was an overall complication rate of 27%.

Postoperative posterior interosseous nerve palsy was the most common complication in this series, occurring in 18% of the patients in spite of identification and protection of the nerve throughout the procedure. High vigilance for compartment syndrome must also be maintained after fixation of any forearm fracture, as it occurred in 1 of 11 patients in this study.