Anatomic considerations for the anterior exposure of the proximal portion of the radius

The rate of posterior interosseous nerve injury is still of major concern during surgical exposure of the proximal portion of the radius. The objective of this study was to find the best way to protect the important neurovascular structures during anterior exposure of the proximal radius and to define the safest anatomic orientation for plate and screw placement during open reduction and internal fixation of the proximal radius. In 30 cadaveric upper limbs, the proximal portion of the radius was exposed through a modified anterior Henry approach. The important anatomic structures were localized and demonstrated on radiographs. Plates and screws were applied anterolaterally (in five specimens) and laterally (in another five specimens), and the locations of the safe and danger zones were noted. Lateral placement of the plate is preferred over the more commonly used anterolateral plating, because it carries less risk of injuring the posterior interosseous nerve during screw application and it does not impinge on the biceps tendon and block pronation.