Abstract
Purpose
The posterior interosseous nerve (PIN) is at risk during the posterior and lateral approaches to the proximal radius. We aimed to define a safe zone for these approaches to avoid injury of the PIN and to evaluate their close and changing relationship to the nerve during forearm rotation.
Methods
The study collective consisted of 50 upper limbs. After performance of the lateral approach, the distance between the tip of the radial head and the PIN’s exit point from the supinator (= distance 1) and the shortest interval between the nerve’s exit to the radial margin of the ulna (= distance 2) were measured in maximum pronation and supination. Then, the dorsal approach was conducted and again distance 1 and the interval between the distal margin of the anconeus and the nerve’s exit point (distance 2) were evaluated (pronation and supination).
Results
There were significantly shorter distances during supination in comparison to pronation. Regarding the lateral approach, distance 1 changed from a mean of 60.3 mm (supination) to 62.7 mm in pronation (p < 0.001). For the dorsal approach, distance 1 decreased significantly (p < 0.001) from 62.9 mm (pronation) to 60.2 mm (supination).
Conclusion
Supination during the lateral and dorsal approaches to the proximal radius needs to be avoided to protect the PIN. Furthermore, the nerve appeared at an interval between 45 and 84.1 mm (lateral approach) and 47.5–93.8 mm (dorsal approach), respectively. Therefore, care must be taken at this height during extension of the approaches in a distal direction.
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References
AO Foundation (2017) AO surgery reference. https://aotrauma.aofoundation.org/Structure/education/self-directed-learning/reference-materials/ao-surgery-reference. Accessed 13 Nov 2017
Artico M, Telera S, Tiengo C et al (2009) Surgical anatomy of the radial nerve at the elbow. Surg Radiol Anat 31:101–106
Bhatia DN, Das Gupta B, Panjwani T (2016) Cadaveric study of anterior and posterior elbow endoscopy portals for endoscopic distal biceps repair: comparative anatomy-at-risk. Surg Radiol Anat 38:781–791
Diliberti T, Botte MJ, Abrams RA (2000) Anatomical considerations regarding the posterior interosseous nerve during posterolateral approaches to the proximal part of the radius. J Bone Jt Surg Am 82:809–813
Dubert T, Oberlin C, Alnot JY (1990) Anatomie des nerfs articulaires du poignet. Application à la technique de dénervation. Ann Chir Main Memb Super 9:15–21
Elgafy H, Ebraheim NA, Rezcallah AT, Yeasting RA (2000) Posterior interosseous nerve terminal branches. Clin Orthop Relat Res 376:242–251
Elgafy H, Ebraheim NA, Yeasting RA (2000) The anatomy of the posterior interosseous nerve as a graft. J Hand Surg Am 25:930–935
Hackl M, Wegmann K, Lappen S, Helf C, Burkhart KJ, Müller LP (2015) The course of the posterior interosseous nerve in relation to the proximal radius: is there a reliable landmark? Injury 46:687–692. https://doi.org/10.1016/j.injury.2015.01.028
Heidari N, Kraus T, Weinberg AM et al (2011) The risk injury to the posterior interosseous nerve in standard approaches to the proximal radius: a cadaver study. Surg Radiol Anat 33:353–357
Hoppenfeld S, deBoer P, Buckley R (2012) Surgical exposures in orthopaedics—the anatomic approach, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 122–137
Kelly EW, Morrey BF, O’Driscoll SW (2000) Complications of repair of the distal biceps tendon with the modified two-incision technique. J Bone Jt Surg Am 82-A:1575–1581
Loh YC, Stanley JK, Jari S, Trail IA (1998) Neuroma of the distal posterior interosseous nerve. A cause of iatrogenic wrist pain. J Bone Jt Surg Br 80:629–630
Mekhail AO, Ebraheim NA, Jackson WT, Yeasting RA (1996) Anatomic considerations for the anterior exposure of the proximal portion of the radius. J Hand Surg Am 21:794–801
R Core Team (2016) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/. Accessed 13 Nov 2017
Raeburn K, Burns D, Hage R et al (2015) Cross-sectional sonographic assessment of the posterior interosseous nerve. Surg Radiol Anat 37:1155–1160
Schimizzi A, MacLennan A, Meier KM, Chia B, Catalano LW 3rd, Glickel SZ (2009) Defining a safe zone of dissection during the extensor digitorum communis splitting approach to the proximal radius and forearm: an anatomic study. J Hand Surg Am 34:1252–1255. https://doi.org/10.1016/j.jhsa.2009.04.026
Strauch RJ, Rosenwasser MP, Glazer PA (1996) Surgical exposure of the dorsal proximal third of the radius: how vulnerable is the posterior interosseous nerve? J Shoulder Elb Surg 5:342–346
Tejwani NC, Mehta H (2007) Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg 15:380–387
Thiel W (1992) The presentation of the whole corpse with natural color. Ann Anat 174:185–195
Wada T, Ogino T, Usui M, Ishii S (1997) Distal posterior interosseous nerve syndrome. Handchir Mikrochir Plast Chir 29:129–132
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GMH: Protocol development; data collection; manuscript writing. AMS: Protocol development; data collection; manuscript editing. MJM: Data analysis; manuscript writing & editing. PG: Data collection; manuscript editing. JD: Data collection; manuscript editing. CG: Data collection; manuscript editing. RK: Data collection; manuscript editing. AG: Protocol development; manuscript editing. AHW: Protocol development; manuscript writing & editing.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Hohenberger, G.M., Schwarz, A.M., Maier, M.J. et al. Safe zone for the posterior interosseous nerve with regard to the lateral and posterior approaches to the proximal radius. Surg Radiol Anat 40, 1025–1030 (2018). https://doi.org/10.1007/s00276-018-2004-6
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DOI: https://doi.org/10.1007/s00276-018-2004-6