The risk injury to the posterior interosseous nerve in standard approaches to the proximal radius: a cadaver study

We present an anatomical study and description of a new surgical technique for arthroscopic treatment of scapholunate ligament injuries. Five cadaver specimens were used to perform the technique. After arthroscopic surgery, anatomic dissection was performed to measure the distances to critical wrist structures such as the posterior interosseous nerve and the radial artery, and the size and position of the plasty. This arthroscopic technique offers three advantages: soft tissue damage is reduced (avoiding an extensive approach and injury to the secondary stabilizers and reducing scar tissue); injury to the posterior interosseous nerve is avoided (maintaining wrist proprioception and the role of the dynamic stabilizers); and a biotenodesis is made that ensures proper placement, tension and functionality of the flexor carpi radialis ligament reconstruction.

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Entrapment of the posterior interosseous nerve by a fibrous band in the dorsal edge of the supinator muscle and erosion of a groove in the proximal radius

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(81)80116-5 ◽

1981 ◽

Vol 6 (5) ◽

pp. 524-526 ◽

Cited By ~ 23

Author(s):

Robert S. Derkash ◽

John J. Niebauer

Keyword(s):

Posterior Interosseous Nerve ◽

Fibrous Band ◽

Proximal Radius ◽

Dorsal Edge ◽

Supinator Muscle

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The posterior interosseous nerve and the posterolateral approach to the proximal radius

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.80b2.0800240 ◽

1998 ◽

Vol 80-B (2) ◽

pp. 240-242 ◽

Cited By ~ 3

Author(s):

J. D. Witt ◽

S. Kamineni

Keyword(s):

Posterolateral Approach ◽

Posterior Interosseous Nerve ◽

Proximal Radius

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Posterior Interosseous Nerve Palsy Resulting from Parosteal Lipoma of the Proximal Radius

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.1.16 ◽

2020 ◽

Vol 38 (1) ◽

pp. 68-69

Author(s):

Sang Bub Lee ◽

Je Wan Lee ◽

Jung Im Seok

Keyword(s):

Nerve Palsy ◽

Posterior Interosseous Nerve ◽

Proximal Radius ◽

Parosteal Lipoma ◽

Posterior Interosseous Nerve Palsy

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The “Sign of Horns” deformity following the Thompson’s approach to the proximal radius—A rare case report and literature review

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2018.01.002 ◽

2019 ◽

Vol 26 (1) ◽

pp. 29-33

Author(s):

Faizaan Rushnaiwala ◽

Naushad Hussain ◽

Avadhut Kulkarni

Keyword(s):

Rare Case ◽

Nerve Palsy ◽

Posterior Approach ◽

Posterior Interosseous Nerve ◽

Rare Occurrence ◽

Proximal Radius ◽

Complex Anatomy ◽

Rare Case Report ◽

Posterior Interosseous Nerve Palsy ◽

Standard Posterior Approach

The Thompson’s approach is used as the standard posterior approach by many surgeons. Although posterior interosseous nerve palsy following the Thompson’s approach has been reported by several authors, isolated paralysis of the extensor digitorum communis (EDC) is a rare occurrence. We report to you a case of isolated paralysis of EDC following the Thompson’s approach in a 14-year-old boy who recovered completely on the 5th postoperative day. Each of the approaches to the proximal radius poses a risk of damage to the posterior interosseous nerve and its branches because of traction. Damage may occur during exposure or implant insertion. Any surgery around the supinator and the radial tunnel region is dangerous because of complex anatomy, lack of intermuscular planes and varying distribution of the radial nerve. Avoiding excessive posterior or ulnar retraction of the EDC and improper dissection can avoid the “sign of horns” deformity following the Thompson’s approach.

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