COURSE OF THE RADIAL NERVE IN THE VULNERABLE AREA ALONG THE SHAFT OF THE HUMERUS: A CADAVERIC STUDY
Background: The radial nerve is the most commonly injured nerve associated with humeral fracture. Moreover, the nerve could be iatrogenically injured during fixation of the humerus.
Objective: The study aimed to identify the course of the radial nerve on the posterior and lateral aspects of the humerus.
Methods: Thirty-three adult embalmed cadaveric specimens were included in the study. The humeral length was determined as the distance between the posterior lateral aspect of the acromion and the lateral epicondyle. The distance between the lateral epicondyle to the posterior and lateral course of the nerve were measured.
Results: The average humeral length was 27.7 (±1.8) cm. The mean distance between the lateral epicondyle and posteromedial point, midposterior point, posterolateral point, midlateral point and anterolateral point were 17.4 (±1.2), 15.2 (±1.0), 12.7 (±0.8), 9.5 (±1.0) and 6.4 (±0.8) cm, respectively.
Conclusion: The high variation of the course of the radial nerve along the humerus was confirmed. The results in the present study can be used as a guide to determine the posterior and lateral course of the radial nerve during surgical exploration and prevent the nerve from iatrogenic injury during orthopedic operation.
Pollock FH, Drake D, Bovill EG, Day L, Trafton PG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am 1981; 63: 239-43.
Shah JJ, Bhatti NA. Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases. Clin Orthop Relat Res 1983; 172: 171-6.
Mohler LR, Hanel DP. Closed fractures complicated by peripheral nerve injury. J Am Acad Orthop Surg 2006; 14: 32-7.
Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005; 87: 1647-52.
Birch R, Bonney G, Dowell J, Hollingdale J. Iatrogenic injuries of peripheral nerves. J Bone Joint Surg Br 1991; 73: 280-2.
Rupp RE, Chrissos MG, Ebraheim NA. The risk of neurovascular injury with distal locking screws of humeral intramedullary nails. Orthopedics 1996; 19: 593-5.
Khan R, Birch R. Iatropathic injuries of peripheral nerves. J Bone Joint Surg Br 2001; 83: 1145-8.
Lin J, Shen PW, Hou SM. Complications of locked nailing in humeral shaft fractures. J Trauma 2003; 54: 943-9.
Chao TC, Chou WY, Chung JC, Hsu CJ. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop 2005; 29: 88-91.
Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH. Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma 2009; 66: 800-3.
An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 2010; 34: 131-5.
Baumann G, Nagy L, Jost B. Radial nerve disruption following application of a hinged elbow external fixator: a report of three cases. J Bone Joint Surg Am 2011; 93: e51.
Caldwell JM, Kim HM, Levine WN. Radial nerve injury associated with application of a hinged elbow external fixator: a report of 2 cases. J Shoulder Elbow Surg 2013; 22: e12-6.
Hoppenfeld S, de Boer P. The humerus. In: Hoppenfeld S, de Boer P, editors. Surgical Exposures in Orthopaedics. The Anatomic Approach. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 67-104.
Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop Relat Res 1995; 320: 149-53.
Uhl RL, Larosa JM, Sibeni T, Martino LJ. Posterior approaches to the humerus: when should you worry about the radial nerve? J Orthop Trauma 1996; 10: 338-40.
Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am 1996; 78: 1690-5.
Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res 2000; 373: 259-64.
Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin W. One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat 2004;17: 26-9.
Carlan D, Pratt J, Patterson JM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg Am 2007; 32: 1177-82.
Chou PH, Shyu JF, Ma HL, Wang ST, Chen TH. Courses of the radial nerve differ between Chinese and Caucasians: clinical applications. Clin Orthop Relat Res 2008; 466: 135-8.
Kamineni S, Ankem H, Patten DK. Anatomic relationship of the radial nerve to the elbow joint: clinical implications of safe pin placement. Clin Anat 2009; 22: 684-8.
Artico M, Telera S, Tiengo C, Stecco C, Macchi V, Porzionato A, Vigato E, Parenti A, De Caro R. Surgical anatomy of the radial nerve at the elbow. Surg Radiol Anat 2009; 31: 101-6.
Apivatthakakul T, Patiyasikan S, Luevitoonvechkit S. Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study. Injury 2010; 41: 169-72.
Chaudhry T, Noor S, Maher B, Bridger J. The surgical anatomy of the radial nerve and the triceps aponeurosis. Clin Anat 2010; 23: 222-6.
Cox CL, Riherd D, Tubbs RS, Bradley E, Lee DH. Predicting radial nerve location using palpable landmarks. Clin Anat 2010; 23: 420-6.
Arora S, Goel N, Cheema GS, Batra S, Maini L. A method to localize the radial nerve using the 'apex of triceps aponeurosis' as a landmark. Clin Orthop Relat Res 2011; 469: 2638-44.
Wegmann K, Lappen S, Pfau DB, Neiss WF, Müller LP, Burkhart KJ. Course of the radial nerve in relation to the center of rotation of the elbow-the need for a rational safe zone for lateral pin placement. J Hand Surg Am 2014; 39: 1136-40.
Clement H, Pichler W, Tesch NP, Heidari N, Grechenig W. Anatomical basis of the risk of radial nerve injury related to the technique of external fixation applied to the distal humerus. Surg Radiol Anat 2010; 32: 221-4.
McKee MD, Larsson S. Humeral shaft fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P III, editors. Rockwood and Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010, p. 999–1038.
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