Irie Tomoyo, Motomiya Makoto, Iwasaki Norimasa
Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Nishi 6 Minami 8-1, Obihiro, 080-0016, Japan.
BMC Res Notes. 2018 Apr 11;11(1):240. doi: 10.1186/s13104-018-3348-z.
Volar locking plate fixation of distal radius fractures is commonly performed because of its good clinical outcomes. The flexor carpi radialis (FCR) approach is one of the most popular approaches to dissecting the volar side of the distal radius because of its simplicity and safety. We describe an extremely rare case of an absent FCR identified during a volar approach for fixation of a distal radius fracture.
A 59-year-old woman with distal radius fracture underwent surgery using the usual FCR approach and volar locking plate. We could not identify the absence of the FCR tendon preoperatively because of severe swelling of the distal forearm. At first, we wrongly identified the palmaris longus tendon as the FCR because it was the tendinous structure at the most radial location of the volar distal forearm. When we found the median nerve just radial to the palmaris longus tendon, we were then able to identify the anatomical abnormality in this case. To avoid iatrogenic neurovascular injuries, we changed the approach to the classic Henry's approach.
Although the FCR approach is commonly used for fixation of distal radius fractures because of its simplicity and safety, this is the first report of complete absence of the FCR during the commonly performed volar approach for fixation of a distal radius fracture, to our knowledge. Because the FCR is designated as a favorable landmark because of its superficially palpable location, strong and thick structure, and rare anatomical variations, there is the possibility of iatrogenic complications in cases of the absence of the FCR. We suggest that surgeons should have a detailed knowledge of the range of possible anomalies to complete the fixation of a distal radius fracture safely.
由于桡骨远端骨折采用掌侧锁定钢板固定具有良好的临床效果，因此该方法被广泛应用。桡侧腕屈肌（FCR）入路因其操作简单且安全，是解剖桡骨远端掌侧最常用的入路之一。我们描述了1例在桡骨远端骨折掌侧入路固定手术中发现FCR缺如的极其罕见的病例。
1例59岁桡骨远端骨折女性患者采用常规FCR入路及掌侧锁定钢板进行手术。由于前臂远端严重肿胀，术前我们未能发现FCR肌腱缺如。起初，我们错误地将掌长肌腱认定为FCR，因为它是掌侧远端前臂最桡侧的肌腱结构。当我们在掌长肌腱桡侧发现正中神经时，才得以确定该病例的解剖异常。为避免医源性神经血管损伤，我们将入路改为经典的亨利入路。
据我们所知，尽管FCR入路因其操作简单且安全常用于桡骨远端骨折固定，但这是首例在桡骨远端骨折掌侧入路固定手术中发现FCR完全缺如的报告。由于FCR因其位置表浅可触及、结构强壮且粗大以及解剖变异罕见而被视为一个良好的标志，FCR缺如时存在发生医源性并发症的可能性。我们建议外科医生应详细了解可能出现的异常范围，以安全地完成桡骨远端骨折的固定。
