Safe zone for the posterior interosseous nerve with regard to the lateral and posterior approaches to the proximal radius
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.
KeywordsPosterior interosseous nerve Proximal radius fracture Lateral approach radius Posterior approach radius
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.
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 was obtained from the body donors during their lifetime.
- 1.AO Foundation (2017) AO surgery reference. https://aotrauma.aofoundation.org/Structure/education/self-directed-learning/reference-materials/ao-surgery-reference. Accessed 13 Nov 2017
- 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
- 14.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
- 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. https://doi.org/10.1016/j.jhsa.2009.04.026 CrossRefPubMedGoogle Scholar