Lateral Approach to the proximal radius (Boyd)

  • Indication

  • Anatomy

  • Considerations

  • Positioning

  • Image

  • Skin incision

  • Superficial dissection

  • Deep dissection

  • Exposure extension

  • Closure

  • Post operatively

  • References

    • Indication

    Access to the proximal radius and radial head. Most commonly used for radial head fractures.

    The Boyd approach allows access to the proximal radius and is particularly indicated for montegia fracture dislocations. Allowing access to the proximal ulna and radial head

     

    Anatomy

    The Boyd approach passes through anconeus, so is not an 'internervous' approach. It reflects supinator from it's postero lateral attachment to avoid damage to the posterior interosseous nerve.

     

    Considerations

    Beware if operating on radius and ulna proximally through this interval risk radioulna synostosis.

    See Wrightington approach uses Boyd interval between anconeus and ulna but includes osteotomy of supinator crest to release annular ligament.

     

    Positioning

    Supine
    Arm Board
    Tourniquet on upper arm (Elevate, Don’t exsanguinate to keep V's engorged).
    Forearm in pronation (protects PIN)

     

    Skin Incision

    A curvilinear incision is used. Running from lateral 2cm of the distal triceps tendon over the radial head and along the proximal 6cm of the subcutaneous border of the ulna.

     

    Superficial dissection

    Expose the superficial fascia.

    Develop the plane anterior to the radial border of the triceps tendon.

    Continue this distally releasing anconeus off the posterior border of the ulna, more distally continue to elevate ECU off the ulna.

     

    Deep dissection

    Elevate anconeus laterally exposing the annular ligament and posterior capsule, distally the ulnar origin of supinator.

    Elevate supinator as a subperiosteal flap and reflect radially.

    (NB The posterior interosseous nerve passes through the belly of supinator. Care should be taken to stay 'on the bone' to avoid damage to the nerve)

     

    Exposure extension

    The approach provides exposure to the proximal 1/4 of the radius, and may be extended proximally up the supracondylar ridge (proximal extension of kocher approach)

    (Do not extend the approach more than 6cm distally due to the risk of damage to the dorsal interosseous artery and radial & posterior interosseous nerve)

     

    Closure

    Repair muscle fascia. If released annular ligament or lateral collateral ligament repair soundly (transosseous suture or mini anchors) to avoid PLRI


     

    Post operatively

    Depends on indication for procedure

     

    References

    Boyd. H. B.: Surgical Exposure of the Ulna and Proximal Third of the Radius through One Incision. Surg. , Gynec. and Obstet,, 71: 87-88, 1940.

     

    Page created by: Ben Ollivere
    Edited by: Lee Van Rensburg
    Last updated 11/09/2015