Surgical and Radiologic Anatomy

, Volume 40, Issue 9, pp 1025–1030 | Cite as

Safe zone for the posterior interosseous nerve with regard to the lateral and posterior approaches to the proximal radius

  • Gloria Maria Hohenberger
  • Angelika Maria Schwarz
  • Marco Johannes Maier
  • Peter Grechenig
  • Jan Dauwe
  • Christoph Grechenig
  • Renate Krassnig
  • Axel Gänsslen
  • Andreas Heinrich Weiglein
Original Article



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.


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).


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).


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.


Posterior interosseous nerve Proximal radius fracture Lateral approach radius Posterior approach radius 


Author contributions

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.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from the body donors during their lifetime.


  1. 1.
  2. 2.
    Artico M, Telera S, Tiengo C et al (2009) Surgical anatomy of the radial nerve at the elbow. Surg Radiol Anat 31:101–106CrossRefPubMedGoogle Scholar
  3. 3.
    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 38:781–791CrossRefPubMedGoogle Scholar
  4. 4.
    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 82:809–813CrossRefGoogle Scholar
  5. 5.
    Dubert T, Oberlin C, Alnot JY (1990) Anatomie des nerfs articulaires du poignet. Application à la technique de dénervation. Ann Chir Main Memb Super 9:15–21CrossRefPubMedGoogle Scholar
  6. 6.
    Elgafy H, Ebraheim NA, Rezcallah AT, Yeasting RA (2000) Posterior interosseous nerve terminal branches. Clin Orthop Relat Res 376:242–251CrossRefGoogle Scholar
  7. 7.
    Elgafy H, Ebraheim NA, Yeasting RA (2000) The anatomy of the posterior interosseous nerve as a graft. J Hand Surg Am 25:930–935CrossRefPubMedGoogle Scholar
  8. 8.
    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. CrossRefPubMedGoogle Scholar
  9. 9.
    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 33:353–357CrossRefPubMedGoogle Scholar
  10. 10.
    Hoppenfeld S, deBoer P, Buckley R (2012) Surgical exposures in orthopaedics—the anatomic approach, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 122–137Google Scholar
  11. 11.
    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:1575–1581CrossRefGoogle Scholar
  12. 12.
    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 80:629–630CrossRefGoogle Scholar
  13. 13.
    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 21:794–801CrossRefPubMedGoogle Scholar
  14. 14.
    R Core Team (2016) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. Accessed 13 Nov 2017
  15. 15.
    Raeburn K, Burns D, Hage R et al (2015) Cross-sectional sonographic assessment of the posterior interosseous nerve. Surg Radiol Anat 37:1155–1160CrossRefPubMedGoogle Scholar
  16. 16.
    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. CrossRefPubMedGoogle Scholar
  17. 17.
    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 5:342–346CrossRefGoogle Scholar
  18. 18.
    Tejwani NC, Mehta H (2007) Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg 15:380–387CrossRefPubMedGoogle Scholar
  19. 19.
    Thiel W (1992) The presentation of the whole corpse with natural color. Ann Anat 174:185–195CrossRefPubMedGoogle Scholar
  20. 20.
    Wada T, Ogino T, Usui M, Ishii S (1997) Distal posterior interosseous nerve syndrome. Handchir Mikrochir Plast Chir 29:129–132PubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Gloria Maria Hohenberger
    • 1
  • Angelika Maria Schwarz
    • 2
  • Marco Johannes Maier
    • 3
  • Peter Grechenig
    • 4
  • Jan Dauwe
    • 5
  • Christoph Grechenig
    • 4
  • Renate Krassnig
    • 1
  • Axel Gänsslen
    • 6
  • Andreas Heinrich Weiglein
    • 7
  1. 1.Department of Orthopaedics and Trauma SurgeryMedical University of GrazGrazAustria
  2. 2.AUVA Trauma Hospital GrazGrazAustria
  3. 3.ViennaAustria
  4. 4.Medical University of GrazGrazAustria
  5. 5.Department of Orthopaedic SurgeryUniversity Hospitals Leuven, Campus PellenbergPellenbergBelgium
  6. 6.Trauma DepartmentKlinikum WolfsburgWolfsburgGermany
  7. 7.Institute of AnatomyMedical University of GrazGrazAustria

Personalised recommendations