Thompson, Ann Surg 1918 - Anatomical Methods of Approach in Operations on the Long Bones of the Extremities

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Anatomical Methods of Approach in Operations on the Long Bones of the Extremities

Thompson·Ann Surg·1918·115 citations·Anatomic study

Free Full Text·DOI·PubMed

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Thompson (1918) systematically describes anatomically safe surgical exposures for every long bone of the upper and lower extremity — radius, ulna, humerus, tibia, fibula, and femur — organized by bone segment. The paper establishes four governing principles (access, nerve preservation, muscle protection, vascular preservation) and defines specific intermuscular intervals, nerve-at-risk landmarks, and clinical indications for each approach.

Key Findings

The Thompson dorsal approach to the radius runs through the interval between extensor digitorum communis (medial) and extensores carpi radialis longus/brevis (lateral), with abductor pollicis longus retracted distally — exposing the middle and upper thirds of the posterior radial shaft without crossing the posterior interosseous nerve
The posterior interosseous nerve defines a precise danger zone within the supinator: it enters ~2 cm below the radiocapitellar joint line laterally and exits ~5 cm below on the posterior surface — retraction beyond these limits risks temporary or permanent extensor paralysis, with one such case documented in this series
Two safe anterior intervals exist for distal radius access, each with distinct indications:
- Between brachioradialis insertion and radial artery (lateral to pronator quadratus): Colles' fractures and epiphyseal osteomyelitis
- Between brachioradialis tendon and extensor carpi radialis longus: lower third of the lateral radial shaft
Four inviolable principles govern all long bone exposures: easy access to the fracture or disease focus; preservation of both sensory and motor nerves; working between (not through) muscles parallel to their fibers; and protection of nutrient and muscular vascular supply
The medial tibial surface is subcutaneous along its full length except the upper fourth, making it the preferred surface for all tibial fracture and osteomyelitis surgery — deliberate exposure of the posterior tibial surface above the lower quarter is contraindicated due to overlying neurovascular structures

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|

Anatomical Methods of Approach in Operations on the Long Bones of the Extremities

Thompson·Ann Surg·1918·115 citations·Anatomic study

Free Full Text·DOI·PubMed

|

Thompson (1918) systematically describes anatomically safe surgical exposures for every long bone of the upper and lower extremity — radius, ulna, humerus, tibia, fibula, and femur — organized by bone segment. The paper establishes four governing principles (access, nerve preservation, muscle protection, vascular preservation) and defines specific intermuscular intervals, nerve-at-risk landmarks, and clinical indications for each approach.

Key Findings

The Thompson dorsal approach to the radius runs through the interval between extensor digitorum communis (medial) and extensores carpi radialis longus/brevis (lateral), with abductor pollicis longus retracted distally — exposing the middle and upper thirds of the posterior radial shaft without crossing the posterior interosseous nerve
The posterior interosseous nerve defines a precise danger zone within the supinator: it enters ~2 cm below the radiocapitellar joint line laterally and exits ~5 cm below on the posterior surface — retraction beyond these limits risks temporary or permanent extensor paralysis, with one such case documented in this series
Two safe anterior intervals exist for distal radius access, each with distinct indications:
- Between brachioradialis insertion and radial artery (lateral to pronator quadratus): Colles' fractures and epiphyseal osteomyelitis
- Between brachioradialis tendon and extensor carpi radialis longus: lower third of the lateral radial shaft
Four inviolable principles govern all long bone exposures: easy access to the fracture or disease focus; preservation of both sensory and motor nerves; working between (not through) muscles parallel to their fibers; and protection of nutrient and muscular vascular supply
The medial tibial surface is subcutaneous along its full length except the upper fourth, making it the preferred surface for all tibial fracture and osteomyelitis surgery — deliberate exposure of the posterior tibial surface above the lower quarter is contraindicated due to overlying neurovascular structures

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