title: The cadaveric anatomy of the distal radius: implications for the use of volar plates.
abstract: BACKGROUND
  Fractures of the distal radius are common upper limb injuries, representing a substantial proportion of the trauma workload in orthopaedic units. With ever increasing advancements in implant technology, operative intervention is becoming more frequent. As growing  numbers of surgeons are performing operative fixation of distal radial fractures, an accurate understanding of the relevant surgical anatomy is paramount. The flexor carpi radialis (FCR) tendon forms the cornerstone of the Henry approach to the volar cortex of the distal radius. A number of  key neurovascular structures around the wrist are potentially at risk during this approach, especially when the FCR is mobilised and placed under retractors.
  
  
  METHODS
  In order to clarify the safe margins of the FCR approach, ten fresh frozen human cadaver limbs were dissected. The  location of the radial artery, the median nerve, the palmar cutaneous branch of the median nerve and the superficial branch nerve were measured with respect to the FCR tendon. Measurements were taken on a centre-to-centre basis in the coronal plane at the watershed level. In addition, the  distances between the tendons of brachioradialis, abductor pollicis longus and flexor pollicis longus, and the radial artery and median nerve were measured to create a complete picture of the anatomy of the FCR approach to the distal radius.
  
  
  RESULTS
  The structure most at risk was  the palmar cutaneous branch of the median nerve. It was located on average 3.4mm from the FCR tendon. The radial artery and the main trunk of the median nerve were located 7.8mm and 8.9mm from the tendon. The superficial branch of the radial nerve was 24.4mm from the FCR tendon and 11.1mm  from the brachioradialis tendon.
  
  
  CONCLUSIONS
  Operative intervention is not without complication. We believe a more accurate understanding of the surgical anatomy is key to the prevention of neurovascular damage arising from the surgical management of distal radial fractures.
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, UK. pasmccann@hotmail.com
authors.forename: P A
authors.initials: PA
authors.lastname: McCann
authors.forename: D
authors.initials: D
authors.lastname: Clarke
authors.forename: R
authors.initials: R
authors.lastname: Amirfeyz
authors.forename: R
authors.initials: R
authors.lastname: Bhatia
mesh_terms: D002102:Cadaver; D006801:Humans; D008475:Median Nerve / Q000033:anatomy & histology*; D053401:Palmar Plate / Q000098:blood supply / Q000294:innervation; D017534:Radial Artery / Q000033:anatomy & histology*; D011884:Radius / Q000033:anatomy & histology* / Q000098:blood supply / Q000294:innervation; D011885:Radius Fractures / Q000601:surgery; D012307:Risk Factors; D013710:Tendons / Q000033:anatomy & histology