import { ComparisonTable, ContentSection, EvidenceCard, ExamCheatSheet, ExamPearl, ExamWarning, InfoCard, InfoCardGrid, MedicalImage, MnemonicCard, OnePagerSummary, SafetyAlert, Tab, Tabs, Timeline, TimelineItem, VivaScenario, VivaScenarioSection } from '@/components/mdx' {/* SECTION 1: ONE-PAGER SUMMARY */} ### Thompson Approach Key Steps {/* SECTION 2: EXAM WARNING */} The **posterior interosseous nerve (PIN)** is at highest risk in this approach (3-11% temporary palsy). PIN enters supinator muscle proximally, spirals around radial neck, and exits at distal supinator border. Protection: (1) Full forearm pronation, (2) Subperiosteal dissection only, (3) Avoid superior dissection beyond radial head. **ECRB (radial nerve)** laterally and **EDC (posterior interosseous nerve)** medially. This is a true internervous plane - splitting between muscles supplied by different terminal branches of the radial nerve. ECRB gets superficial branch, EDC gets deep branch (PIN). **Full pronation is mandatory** throughout dissection. Pronation moves the PIN laterally and anteriorly, away from the radius. This creates maximum distance between nerve and operative field. Any supination during dissection dramatically increases nerve injury risk. The **supinator muscle wraps around proximal radius** and contains the PIN within its substance. NEVER dissect through supinator - always stay subperiosteal. PIN exits supinator at its distal border (approximately 5cm distal to radial head). Subperiosteal elevation protects the nerve. {/* SECTION 2.5: QUICK DECISION GUIDE */} {/* SECTION 3: MNEMONICS */} {/* SECTION 4: OVERVIEW */} The **Thompson approach** (also called the dorsal approach to the radius) is a true internervous approach providing excellent exposure of the proximal and middle thirds of the radius. First described by Thompson in 1918, it remains the gold standard for proximal radial shaft fractures and radial head/neck pathology requiring plate fixation. **Historical development:** - **Thompson (1918)**: Original description for radial shaft access - **Henry (1927)**: Described volar approach as alternative for distal radius - **Boyd (1940)**: Modified Thompson approach with interval preservation - **Modern refinements**: PIN monitoring, subperiosteal technique emphasis **Clinical significance:** - Most commonly used approach for proximal radius fractures requiring plate fixation - True internervous plane minimizes denervation risk - Allows access to radial head, neck, and proximal shaft through single approach - Can extend distally but limited by PIN anatomy at distal supinator border The **Thompson (dorsal) approach** is preferred over the **Henry (volar) approach** for proximal radius because: (1) Thompson provides direct posterior access to common fracture displacement direction, (2) Henry approach requires dissection through multiple muscle layers volarly and risks radial artery, (3) Thompson is internervous while Henry splits pronator teres (median nerve territory), (4) Plate placement on dorsal radius is biomechanically superior for most fracture patterns. **Internervous plane:** - **Between:** Extensor carpi radialis brevis (ECRB) and Extensor digitorum communis (EDC) - **ECRB nerve supply:** Radial nerve (superficial branch) - **EDC nerve supply:** Posterior interosseous nerve (deep branch of radial) - This is a true internervous plane between two terminal branches of the radial nerve **Anatomical boundaries:** - **Proximal limit:** Radial head (PIN spirals around neck immediately superior) - **Distal limit:** Junction of middle and distal thirds (PIN emerges from supinator) - **Lateral:** ECRB muscle belly - **Medial:** EDC muscle belly {/* SECTION 5: RELEVANT ANATOMY */} **Understanding radial nerve anatomy is critical** for safe execution of the Thompson approach. **Radial nerve division:** - Radial nerve proper lies anterior to lateral epicondyle - Divides into two terminal branches: - **Superficial branch (sensory):** Continues distally under brachioradialis - **Deep branch (motor - PIN):** Enters supinator muscle through arcade of Frohse **Posterior interosseous nerve (PIN) course:** **Supinator muscle:** - **Superficial head:** Arises from lateral epicondyle, supinator crest of ulna - **Deep head:** Arises from supinator crest - **Insertion:** Wraps around proximal radius, inserts on anterior, lateral, posterior surfaces - **Function:** Supination of forearm - **Clinical importance:** Contains PIN within its substance - NEVER dissect through supinator **Effect of forearm position on PIN:** PIN wrapped tightly around radial neck, closest to bone Minimal distance between nerve and surgical field HIGH RISK position - never dissect in supination PIN partially relaxed but still close to radius Some distance created but not maximal Suboptimal positioning for dissection PIN moved laterally and anteriorly, maximum distance from radius Supinator muscle relaxed, nerve protected MANDATORY position for Thompson approach **Surface anatomy and landmarks:** - **Lateral epicondyle** - palpable proximal landmark - **Radial head** - palpable with forearm rotation, 2cm distal to lateral epicondyle - **Lister tubercle** - palpable on dorsal distal radius (distal landmark) - **Incision line** - from lateral epicondyle toward Lister tubercle **Muscles in the approach:** **Extensor carpi radialis brevis (ECRB):** Lies lateral (radial) in the approach. Muscle belly visible, tendon runs to base of 3rd metacarpal. Supplied by radial nerve directly (not PIN). **Extensor digitorum communis (EDC):** Lies medial (ulnar) in the approach. Muscle belly with four tendons to fingers. Supplied by posterior interosseous nerve. **Critical distinction:** Splitting between these muscles creates internervous plane. Never confuse EDC with ECRB - they have different nerve supplies. **Vascular anatomy:** - Posterior interosseous artery runs with PIN through supinator - Radial artery lies anterior (safe from Thompson approach) - Minimal bleeding if subperiosteal technique used - Cautery safe once subperiosteal plane established {/* SECTION 5.5: INTERNERVOUS PLANE */} ### True Internervous Interval The Thompson approach utilizes a **true internervous plane** between muscles supplied by different terminal branches of the radial nerve. **The Plane:** - **Between:** Extensor carpi radialis brevis (ECRB) AND Extensor digitorum communis (EDC) - **ECRB nerve supply:** Radial nerve (superficial branch) - **EDC nerve supply:** Posterior interosseous nerve (deep branch of radial nerve) **Clinical Significance:** This is a true internervous approach because ECRB and EDC receive innervation from different terminal branches of the radial nerve. The radial nerve divides at the level of the lateral epicondyle into: 1. **Superficial branch (sensory):** Continues under brachioradialis, supplies ECRB 2. **Deep branch (motor - PIN):** Penetrates supinator, supplies EDC and other extensors The **Thompson approach is truly internervous** because it works between ECRB (radial nerve territory) and EDC (PIN territory). This differs from approaches that split a single muscle or work between muscles with the same nerve supply. True internervous dissection minimizes denervation and preserves muscle function on both sides of the interval. **Identifying the interval:** - ECRB lies lateral (radial side), has thicker muscle belly - EDC lies medial (ulnar side), has multiple visible tendons - Natural cleavage plane exists between muscles - Palpate for groove between muscle bellies - Trace tendons distally to confirm: ECRB to 3rd metacarpal base, EDC to fingers The internervous nature of this approach is a key advantage over muscle-splitting or muscle-dividing approaches. {/* SECTION 6: INDICATIONS */} **Fractures:** - **Proximal radius shaft fractures** - most common indication - **Radial head fractures** - if plate fixation required (Mason III/IV) - **Radial neck fractures** - displaced fractures requiring ORIF - **Mid-shaft radius fractures** - proximal two-thirds accessible - **Radial shaft malunions** - corrective osteotomy and fixation **Tumor pathology:** - **Osteochondroma** - excision from proximal radius - **Enchondroma** - curettage and bone grafting - **Giant cell tumor** - excision and reconstruction - **Benign bone tumors** requiring surgical access **Infection:** - **Chronic osteomyelitis** - debridement and fixation - **Sequestrum removal** - access to infected bone **Other indications:** - **Radial head excision** - for severe comminution or arthrosis - **Radial head arthroplasty** - preparation for implant placement - **Synovectomy** - rheumatoid arthritis affecting proximal radius The Thompson approach provides excellent access to proximal and mid-shaft radius pathology. **Absolute contraindications:** - **Active soft tissue infection** overlying approach site - **Distal radius pathology** - use Henry approach instead - **Patient unable to tolerate forearm pronation** (contracture, arthritis) **Relative contraindications:** - **Previous PIN injury** - increased risk of further damage - **Extensive soft tissue injury** - may need alternative approach - **Need for both-bone forearm fixation** - consider single-incision techniques - **Severe osteoporosis** - fixation concerns regardless of approach **When NOT to use Thompson:** - **Distal third radius fractures** - PIN anatomy limits safe dissection - **Volar displaced fractures** - may be better accessed volarly - **Isolated ulna fractures** - separate approach indicated - **Pediatric fractures** - often managed non-operatively or with pinning Understanding approach limitations prevents complications and ensures appropriate patient selection. **Thompson vs Henry approach:** | Factor | Thompson (Dorsal) | Henry (Volar) | |--------|------------------|---------------| | **Best for** | Proximal 2/3 radius | Distal 1/3 radius | | **Internervous** | Yes (ECRB/EDC) | No (splits pronator teres) | | **Nerve at risk** | PIN (3-11% palsy) | Radial artery, median nerve | | **Plate position** | Dorsal (tension side) | Volar (compression side) | | **Extensibility** | Limited distally by PIN | Can extend length of radius | **Decision factors:** - Fracture location (proximal = Thompson, distal = Henry) - Displacement direction (dorsal = Thompson, volar = Henry) - Surgeon experience and preference - Need for radial head access (Thompson better) Most surgeons use Thompson for proximal two-thirds and Henry for distal third. {/* SECTION 7: PREOPERATIVE PLANNING */} **Clinical assessment:** - **Mechanism of injury** - direct blow vs fall on outstretched hand - **Neurovascular examination** - PIN function (finger/thumb extension), radial pulse - **Skin condition** - open fracture, abrasions, soft tissue injury - **Associated injuries** - ulna fracture, elbow dislocation, wrist injury **PIN function testing:** - **Finger extension at MCP joints** - EDC function - **Thumb extension at IP and MCP** - EPL and EPB function - **Index finger extension/abduction** - EIP function - **Document carefully** - medicolegal importance if post-op deficit occurs **Imaging protocol:** AP and lateral forearm views AP and lateral elbow views (assess radial head) AP and lateral wrist views (assess distal radioulnar joint) Assess: fracture location, displacement, comminution, associated injuries Indications: radial head fractures, proximal radius comminution, malunion 3D reconstruction helpful for surgical planning Assess articular involvement and fragment size If complex deformity or malunion Template for reconstruction **Surgical planning:** - **Fracture pattern analysis** - determine fixation strategy - **Implant selection** - plate length, screw configuration - **Bone graft assessment** - needed for comminution or malunion - **Approach modifications** - extent of exposure required **Complete PIN examination** requires testing all muscles supplied: (1) **Extensor digitorum** - extend all fingers at MCP (patient makes fist then extends), (2) **Extensor pollicis longus** - extend thumb IP joint against resistance, (3) **Extensor indicis proprius** - extend index finger independently, (4) **Abductor pollicis longus** - abduct thumb in plane of palm. Document normal function preoperatively - if post-op deficit occurs, you have baseline for comparison. **Equipment checklist:** - Radiolucent hand table or arm board - Tourniquet (upper arm) - 3.5mm compression or locking plate system - Small fragment instruments (screws, drill bits) - Bone graft if needed (iliac crest or substitute) - Image intensifier {/* SECTION 8: SURGICAL TECHNIQUE */} **Patient position:** - **Supine** on operating table - Radiolucent hand table attached on affected side - Alternatively: arm across chest on radiolucent bolster **Arm positioning:** - Shoulder abducted 90 degrees (if using hand table) - Elbow flexed 90 degrees - **Forearm pronated maximally** - CRITICAL for PIN protection - Secure position with towels or positioning devices **Tourniquet:** - Upper arm tourniquet applied but not inflated initially - Inflate only after exsanguination - Deflate before closure to check hemostasis - Typical inflation pressure: 250mmHg (adjust for patient size) **Imaging setup:** - Image intensifier positioned to allow AP and lateral forearm views - Check imaging adequate before draping - Surgeon and assistant positioned to optimize visualization **Skin preparation:** - Prepare entire forearm from elbow to wrist - Include hand if radial head manipulation needed - Standard antiseptic protocol (chlorhexidine or povidone-iodine) Proper positioning with maximal forearm pronation is the foundation for safe PIN protection. ### Skin Incision **Incision planning:** - Begins at lateral epicondyle - Extends distally toward Lister tubercle on wrist - Length depends on extent of exposure (typically 8-12cm) - Slightly curved, following natural skin lines **Subcutaneous dissection:** - Incise skin and subcutaneous tissue - Develop flaps to expose deep fascia - Identify and protect superficial veins (ligate if necessary) - Preserve cutaneous nerves if encountered **Key landmarks:** - Lateral epicondyle palpable proximally - Radial head palpable with forearm rotation - Mobile wad muscles (brachioradialis, ECRL, ECRB) laterally - Extensor muscle mass medially Expose deep fascia overlying extensor muscles Fascia appears white and glistening Identify raphe between ECRB and EDC Palpate interval between ECRB (lateral, firmer) and EDC (medial, softer) Natural cleavage plane exists between muscles Incise fascia in line with muscle fibers Use blunt dissection (fingers or scissors) to develop interval ECRB retracts laterally, EDC retracts medially Minimal force required if correct plane identified The **ECRB-EDC interval** can be identified by: (1) ECRB has a **thicker, more prominent muscle belly** laterally, (2) EDC is **thinner and more tendinous** medially with visible multiple tendons, (3) Palpate with finger - a **natural groove exists** between the muscles, (4) ECRB tendon inserts on **base of 3rd metacarpal** (palpate distally to confirm), (5) EDC has **four tendons to fingers** (visible if exposure extended). If uncertain, trace tendons distally to confirm identity. Correct identification of the ECRB-EDC interval is critical for true internervous dissection. ### Critical Step - Supinator and PIN Protection **Forearm position verification:** Before proceeding with deep dissection, verify forearm is in **maximal pronation**. This is NON-NEGOTIABLE. Pronation moves the PIN laterally and anteriorly, creating maximum distance from the radius. Check pronation repeatedly during case - any supination dramatically increases nerve injury risk. If assistant is holding arm, ensure position maintained throughout. **Deep dissection principles:** Once muscle interval developed, identify radius through muscle depths Periosteum appears as white layer adherent to bone Proximal radius covered by supinator muscle attachments Make longitudinal periosteal incision along dorsal radius Use scalpel to incise periosteum sharply Avoid extending incision too far proximally (PIN risk at radial neck) Use periosteal elevator to strip supinator off radius Work from distal to proximal Stay directly on bone - subperiosteal plane protects PIN Supinator elevates as complete muscle mass with PIN protected within Continue subperiosteal elevation until fracture visible Clear hematoma and periosteum from fracture ends Assess fracture pattern and plan reduction **PIN protection mantras:** - **"Stay on bone"** - subperiosteal plane at all times - **"Pronation protects"** - check forearm position repeatedly - **"Never dissect supinator"** - muscle contains the nerve - **"Distal to proximal"** - direction of elevation protects nerve **What NOT to do:** - Never dissect through supinator muscle belly - Never extend dissection superior to radial head - Never supinate forearm during dissection - Never use sharp dissection in supinator - elevators only Subperiosteal elevation with maximal pronation is the key to PIN safety. ### Fracture Management **Fracture exposure:** - Clear hematoma and soft tissue from fracture site - Identify fracture ends and assess pattern - Remove periosteum from fracture ends for bone-to-bone contact - Assess comminution and bone quality **Reduction techniques:** Assistant applies traction to forearm Surgeon manipulates fracture fragments Use bone clamps to hold provisional reduction Check alignment with image intensifier (AP and lateral) Place reduction clamps or temporary K-wires Verify reduction quality before plating Less than 2mm gap acceptable, anatomic alignment critical Check rotation by aligning radial tuberosity Apply plate to dorsal radius surface Plate should span fracture with 3 screws minimum each side Compression plating for transverse fractures Bridge plating for comminuted fractures Verify screw lengths do not penetrate volar cortex **Plate positioning:** - Dorsal surface of radius (accessible through Thompson approach) - Proximal screws: ensure do not violate radial head articular surface - Distal screws: safe to distal margin of approach (middle third) - Check rotation: radial tuberosity should point anteromedially **Fixation principles:** - 3.5mm compression or locking plate system - Minimum 6 cortices (3 screws) each side of fracture - Lag screws for oblique fracture lines if applicable - Compression at fracture site for simple patterns - Bridge plating for comminuted segments **Image intensifier assessment:** - AP view: alignment, plate position, screw lengths - Lateral view: rotation, no dorsal angulation, hardware position - Oblique views if radial head involved - Ensure screws do not protrude volarly (risk to anterior structures) Stable fixation with anatomic reduction is the goal for optimal healing. ### Wound Closure **Hemostasis:** - Deflate tourniquet before closure - Achieve meticulous hemostasis with cautery - Check for bleeding from periosteal vessels - Irrigate wound thoroughly **Layer closure:** Approximate ECRB and EDC fascia with absorbable suture 2-0 Vicryl running or interrupted sutures This recreates muscle interval Do not close too tightly - avoid muscle ischemia Close subcutaneous tissue with 3-0 Vicryl Eliminate dead space to reduce hematoma risk Running subcuticular technique preferred Skin closure with 4-0 monocryl subcuticular or staples Ensure skin edges well-approximated Apply skin closure strips if desired **Dressing:** - Sterile gauze over incision - Soft bulky dressing around forearm - Sugar-tong splint: elbow 90 degrees, forearm neutral rotation - Splint includes elbow to wrist, protects fixation **Post-closure checks:** - Verify PIN function in recovery (finger extension, thumb extension) - Check radial pulse and capillary refill - Document neurovascular status post-operatively - Post-op radiographs (AP and lateral forearm) Meticulous closure and post-operative assessment complete the procedure safely. {/* SECTION 10: COMPLICATIONS AND STRUCTURES AT RISK */} **Posterior interosseous nerve (PIN) palsy:** - **Most feared complication** of Thompson approach - Incidence 3-11% in published series (higher than volar approaches) - **Risk factors:** Supination during dissection, dissection through supinator, extension too proximal - **Presentation:** Loss of finger MCP extension, thumb extension (wrist extension preserved - ECRL/ECRB intact) - **Natural history:** Most are neuropraxias that recover spontaneously over 3-6 months - **Management:** Observation for 6 months, EMG at 6-12 weeks to confirm neuropraxia, splinting to prevent contractures - **When to explore:** Complete palsy not recovering at 6 months, or if nerve known to be lacerated **PIN palsy prevention strategy:** 1. Maximal forearm pronation throughout approach 2. Strict subperiosteal dissection - stay directly on bone 3. Never dissect through supinator muscle 4. Avoid superior extension of dissection beyond radial head 5. Work distal to proximal when elevating supinator 6. Verify PIN function in recovery room immediately **PIN palsy presents as:** (1) Inability to extend fingers at MCP joints (hand droops when wrist extended), (2) Inability to extend thumb at IP joint, (3) **PRESERVED wrist extension** (ECRL and ECRB are radial nerve, not PIN), (4) No sensory loss (PIN is pure motor). **Differential diagnosis:** Radial nerve palsy includes wrist drop and dorsal hand numbness. If PIN palsy recognized, document carefully, reassure patient most recover, arrange EMG at 6 weeks, provide night splint to prevent MCP flexion contractures. **Superficial radial nerve injury:** - Sensory branch at risk during superficial dissection - Presents as numbness over dorsal radial hand and thumb - Usually resolves but may have persistent dysesthesia - Prevention: careful superficial dissection, protect visible nerves **Hardware-related complications:** - Dorsal radius plate may be prominent and irritating - Hardware removal after fracture healing (12-18 months) if symptomatic - Use low-profile plates to minimize prominence {/* SECTION 10: POSTOPERATIVE CARE */} Sugar-tong splint: elbow 90 degrees, forearm neutral Elevation to reduce swelling Finger and shoulder ROM exercises Wound check at 10-14 days, suture/staple removal Verify PIN function at first visit Transition to removable forearm splint or brace Begin elbow and forearm ROM exercises (gentle) Active-assisted wrist ROM No lifting, no weight-bearing on affected arm X-rays at 6 weeks to assess healing Progressive ROM exercises for elbow, forearm, wrist Light strengthening exercises (1-2 kg weights) Proprioception and coordination exercises X-rays at 12 weeks - expect bridging callus Progressive strengthening to full strength Return to unrestricted activities once healed Consider hardware removal if prominent (after 12 months minimum) Final follow-up at 6 months with X-rays **Early post-operative monitoring:** - **PIN function assessment** - critical in first 24 hours - If deficit present: document, EMG at 6 weeks, observe for recovery - Pain control: multimodal analgesia (paracetamol, NSAIDs, opioids if needed) - DVT prophylaxis not typically needed for upper limb **Splinting protocol:** - Initial: sugar-tong splint (elbow to metacarpals, forearm neutral) - Protects fracture fixation and limits rotation - Transition to removable splint at 2 weeks once wounds healed - Discontinue splint at 6 weeks if healing adequate **Return to activities:** - **Light activities:** 6 weeks (desk work, light ADLs) - **Moderate activities:** 12 weeks (driving, lifting up to 5kg) - **Heavy activities:** 4-6 months (manual labor, contact sports) - **Return to sport:** 6 months or when full strength recovered **Long-term outcomes:** - Union rate greater than 95% with stable fixation - Full ROM typically achieved by 6 months - Strength returns to 90-95% of contralateral by 1 year - PIN palsies recover in 85-90% of cases by 6 months - Hardware removal required in 15-20% for prominence {/* SECTION 11: EVIDENCE BASE */} {/* SECTION 12: VIVA SCENARIOS */} {/* SECTION 13: MCQ PRACTICE POINTS */} **Q: What is the internervous plane in the Thompson approach to the radius?** A: The Thompson approach works between **extensor carpi radialis brevis (ECRB)** and **extensor digitorum communis (EDC)**. ECRB is supplied by the radial nerve (superficial branch), while EDC is supplied by the posterior interosseous nerve (deep branch of radial). This is a true internervous plane. **Q: Where does the posterior interosseous nerve exit the supinator muscle?** A: The PIN exits the supinator muscle at its **distal border, approximately 5cm distal to the radial head**. This represents the safe distal limit of the Thompson approach. Dissection beyond this level risks direct nerve injury. **Q: Why is maximal pronation important during the Thompson approach?** A: Maximal pronation moves the PIN **laterally and anteriorly, away from the radius**, creating maximum distance between the nerve and the surgical field. This is the single most important maneuver for protecting the PIN during Thompson approach. **Q: How do you distinguish PIN palsy from radial nerve palsy clinically?** A: **PIN palsy:** Loss of finger MCP extension and thumb extension, but **PRESERVED wrist extension** (ECRL/ECRB intact). **Radial nerve palsy:** Includes wrist drop (ECRL/ECRB affected) plus finger/thumb extension loss plus sensory loss over dorsal hand. Preserved wrist extension indicates PIN injury distal to radial nerve branching. **Q: What is the key technique to avoid PIN injury during Thompson approach?** A: **Strict subperiosteal dissection** - staying directly on the radius bone and elevating the supinator muscle as a complete mass without dissecting through it. The PIN is contained within the supinator, so subperiosteal elevation protects the nerve. Never dissect through the supinator muscle belly. {/* SECTION 14: AUSTRALIAN CONTEXT */} **Public System Coverage:** - Open reduction and internal fixation of radius/ulna fractures covered under public hospital system - Thompson approach procedures fully funded - Surgical complexity appropriately covered **Therapeutic Guidelines (eTG) recommendations:** - **Antibiotic prophylaxis:** Single dose cefazolin 2g IV within 60 minutes of incision - If penicillin allergy: vancomycin 15-20mg/kg IV over 60-90 minutes - Duration: single dose adequate for clean orthopaedic cases (redose if surgery exceeds 4 hours) **PBS (Pharmaceutical Benefits Scheme):** - Indomethacin for heterotopic ossification prophylaxis (not specifically subsidized for orthopaedics) - Post-operative analgesia: paracetamol, NSAIDs, opioids as needed **Australian epidemiology:** - Radial shaft fractures account for 15-20% of forearm fractures in adults - Peak incidence: males 20-40 years (sporting/high-energy trauma) - Increasing incidence with aging population (falls) **Australian Orthopaedic Association (AOA) guidelines:** - Operative fixation indicated for displaced radial shaft fractures (greater than 50% displacement or greater than 10 degrees angulation) - Thompson approach recommended for proximal two-thirds - Post-operative rehabilitation protocols aligned with international standards **Workers compensation considerations:** - Radial fractures from workplace falls common in construction/manual labor - Return to work timeline: 12-16 weeks for manual workers - Permanent impairment assessed at 12 months if residual restriction **Training and education:** - Thompson approach taught in RACS Orthopaedic Surgery Training Program - Included in SET (Surgical Education and Training) curriculum for upper limb module - FRACS examination: candidates expected to describe approach, anatomy, and complications {/* SECTION 15: EXAM CHEAT SHEET */}

Thompson (Dorsal) Approach to the Radius

Thompson (Dorsal) Approach to the Radius