Anatomic reasons for the iatrogenic injury of deep branches of radial nerve in the Thompson approach in the proximal forearm and its countermeasures
SHAN Jian-lin, WANG Chong-wei, REN Da-jiang, NIE Zheng
Chinese Journal of Clinical Anatomy ›› 2016, Vol. 34 ›› Issue (2) : 130-133.
Anatomic reasons for the iatrogenic injury of deep branches of radial nerve in the Thompson approach in the proximal forearm and its countermeasures
Objective To explore anatomic reasons for the iatrogenic injury of the deep branches of the radial nerve in the Thompson approach in the proximal forearm and propose countermeasures. Methods Forty-eight upper limbs from skeletally mature embalmed cadavers were studied. After Thompson approach was performed, the anatomic relationships of forearm extensor to the deep branches of radial nerve was observed. The transverse distance between the ulnar edge of the extensor carpi radialis brevis and the point where the deep branch of radial nerve exits from the supinator was measured, the fusing condition of the extensor digitorum communis with the extensor carpi radialis brevis at proximal forearm was observed, and the length of its fusion was measured. Results extensor digitorum communis and the extensor carpi radialis brevis fused at the proximal forearm, approximately （7.1±2.1）cm distally from the humeroradial joint.The transverse distance between the ulnar edge of the extensor carpi radialis brevis and the point where the deep branch of radial nerve exits from the supinator was （1.3±0.3）cm, and the distance between the humeroradial joint and this point was （6.1±1.8）cm. Conclusion There are anatomic reasons for the profound branches of radial nerve to be vulnerable to being injured during the Thompson approach. Its anatomic features and location relationship with other structures of forearm can be used to avoid iatrogenic injury.
[1] Spinner RJ,Berger RA,Carmichael SW,et al. Isolated paralysis of the extensor digitorum communis associated with the posterior (Thompson) approach to the proximal radius[J]. J Hand Surg Am, 1998 , 23(1):135-141.
[2] Canale ST, Beaty JH. Campbell’s operative orthopaedics[M]. 11th ed. Philadephia: Mosby, 2008:117.
[3] Kim DH, Murovic JA, Kim YY,et al. Surgical treatment and outcomes in 45 cases of posterior interosseous nerve entrapments and injuries[J].J Neurosurg, 2006, 104(5):766-777.
[4] 王学谦，娄思权，侯筱魁，译. 创伤骨科学[M].天津: 天津科技翻译出版公司，2007：1337.
[5] 单建林，姜恒，孙天胜，等．桡神经深支的体表定位及其临床意义[J].中国临床解剖学杂志，2004, 7(4):347-349.
[6] Capener N. The vulnerability of the posterior interosseous nerve in the forearm. A case report and anatomical study[J]. J Bone Joint Surg Br, 1966,48(4):770-773.
[7] Davies F, Laird M. The supinator muscle and the deep radial,posterior interosseous, nerve[J]. Anat Rec, 1948, 101(2):243-250.
[8] Witt JD, Kamineni S. The posterior interosseous nerve and the posterolateral approach to the proximal radius[J] J Bone Joint Surg Br, 1998, 80(2):240-242.
[9] Mekhail AO, Ebraheim NA, Jackson WT, et al. Anatomic considerations for the anterior exposure of the proximal portion of the radius[J]. J Hand Surg Am, 1996, 21(5):794-801.
[10] Mekhail AO, Ebraheim NA, Jackson WT, et al. Vulnerability of the posterior interosseous nerve during proximal radial exposures [J]. Clin Orthop Rel Res,1995, (1):199-208.
[11] Strachan JCH, Ellis BW. Vulnerability of the posterior interosseous nerve during radial head resection[J]. J Bone Joint Surg Br,1971, 53(2):320-323.
[12] Tornetta P, Hockwald N, Bono C,et al. Anatomy of the posterior interosseous nerve in relation to fixation of the radial head[J]. Clin Orthop Rel Res , 1997,345(12):215-218.
[13] Strauch RJ, Rosenwasser MP, Glazer PA, et al. Surgical exposure of the dorsal proximal third of the radius: how vulnerable is the posterior interosseous nerve [J] ? J Shoulder Elbow Surg, 1996, 5(5):342-346.
[14] Prasartritha T, Liupolvanish P, Rojanakit A. A study of the posterior interosseous nerve (PIN) and the radial tunnel in 30 Thai cadavers[J]. J Hand Surg Am, 1993, 18(1):107-112.
[15] Thompson JE. Anatomical methods of approach in operations of the long bones of the extremities[J]. Ann Surg, 1918,68(3):309-329.
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