Abstract
Purpose
Full or selective wrist denervation is an effective treatment for chronic wrist pain. In this cadaveric study, a volar approach for prophylactic denervation of the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN) was assessed, which can simultaneously be performed during volar approaches for distal radius fracture fixation or in combination with metalwork removal.
Materials and methods
In total 40 adult upper limbs, embalmed using Thiel’s method, were investigated. Group 1 included 20 limbs of which the distances between AIN and PIN to the ulnar margin of radius were measured at levels 6, 8 and 10 cm proximal to the styloid process and the distance radial styloid process to proximal border of pronator quadratus which might be useful as an intraoperative landmark. Subsequently further additional 20 adult limbs (group 2) were used. Transection of the PIN via this volar approach at the evaluated best level of step 1 was performed and evaluated by dissection via a dorsal approach.
Results
In group 1, the PIN runs within the interosseous membrane, from the ulnar border of the radius, 6.4 mm (SD 2.66) at 6 cm, 8.4 mm (SD 2.28) at 8 cm and 3.75 mm (SD 5.46) at 10 cm proximal to the radial styloid. The AIN runs within the interosseous membrane, from the ulna edge of the radius, 7.5 mm (SD 2.4) at 6 cm, 7.3 mm (SD 1.95) at 8 cm and 2.35 mm (3.42) at 10 cm proximal to the radial styloid. AIN and PIN were in close proximity at the 8-cm level which equals a 1-cm distance proximal to the pronator quadratus border. Group 2 showed a successful transection of the PIN through a single volar surgical approach in additional 18 out of 20 adult upper limbs.
Conclusions
This study shows the local anatomy of the PIN, allowing denervation via a volar approach.
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We specially thank Miss Elisabeth Weilharter for revising the manuscript.
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The bodies were donated to science to the Department of Anatomy of the Medical University Graz under the approval of the Anatomical Donation Program of the University of Graz. The experiments comply with the current laws of Austria where they were performed.
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Grechenig, S., Lidder, S., Dreu, M. et al. Wrist denervation of the posterior interosseous nerve through a volar approach: a new technique with anatomical considerations. Surg Radiol Anat 39, 593–599 (2017). https://doi.org/10.1007/s00276-016-1783-x
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DOI: https://doi.org/10.1007/s00276-016-1783-x