Forearm – Volar Approach (Henry’s)

Modern Study Review (AI-Generated)

High-Yield Summary

The Volar (Henry’s) approach is the gold standard for surgical exposure of the radius and ulna shafts, primarily used for fracture fixation, nonunion repair, and hardware removal. It provides excellent visualization of the volar forearm compartments through a safe internervous plane between the radial and median nerves, minimizing soft tissue disruption. This approach remains widely adopted in modern orthopaedics, with modifications for minimally invasive plating techniques enhancing recovery.

Applied Anatomy & Intervals

Internervous Interval

Between the radial nerve (superficial branch) and the median nerve, specifically the plane between the brachioradialis (radial nerve) and pronator teres (median nerve).

Anatomic Landmarks

• Radial styloid distally
• Biceps tendon proximally
• Mobile wad muscles (brachioradialis, extensor carpi radialis longus and brevis) laterally
• Pronator teres medially

Patient Positioning & Setup

• Table Type: Standard operating table with arm board attachment
• Patient Position: Supine, arm abducted on arm board, forearm supinated
• Specialized Equipment:
• Pneumatic tourniquet on upper arm for bloodless field
• C-arm fluoroscopy positioned contralaterally for intraoperative imaging
• Limb positioner or assistant to maintain forearm supination and elbow flexion

Surgical Technique (The “Vital Steps”)

Incision & Superficial Dissection

• Longitudinal incision centered over the radial border of the forearm, from just distal to the elbow crease to the wrist flexion crease
• Identify and protect the lateral antebrachial cutaneous nerve
• Incise fascia over brachioradialis and pronator teres

Deep Dissection & Exposure

• Retract brachioradialis laterally with the radial nerve and its branches
• Retract pronator teres medially with the median nerve
• Identify and protect the radial artery lying deep and medial to brachioradialis
• Expose the radius by elevating the pronator quadratus off the volar surface distally
• For ulna exposure, extend dissection medially, carefully protecting the ulnar nerve proximally and flexor muscles

The “Danger Zone”

Post-Operative Pearl

Early gentle range of motion is encouraged to prevent stiffness; however, avoid forceful supination/pronation against resistance for 4-6 weeks to protect soft tissue healing.

Classic Clinical Notes

Forearm – volar approach (Henry’s)

• Position: supine with tourniquet

Last Updated on January 25, 2026 by orthonet