Vulnerability of the Posterior Interosseous Nerve During Proximal Radius Exposures

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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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

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198304000-00054 ◽

1983 ◽

Vol 71 (4) ◽

pp. 585

Author(s):

J. Kenneth Chong

Keyword(s):

Posterior Interosseous Nerve ◽

Fibrous Band ◽

Proximal Radius ◽

Dorsal Edge ◽

Supinator Muscle

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The Relationship of the Posterior Interosseous Nerve to the Supinator Muscle in the Dorsal Approach to the Proximal Radius: A Descriptive and Quantitative Anatomic Study of Filipino Cadavers

Acta Medica Philippina ◽

10.47895/amp.v51i2.586 ◽

2017 ◽

Vol 51 (2) ◽

Author(s):

Leslie M. Reyes ◽

Phillip Anthony B. Kho ◽

Edward H.M. Wang

Keyword(s):

Reference Line ◽

Posterior Interosseous Nerve ◽

Entry And Exit ◽

Anatomic Landmarks ◽

Dorsal Approach ◽

Lateral Epicondyle ◽

Proximal Radius ◽

Supinator Muscle ◽

The Mean ◽

Relationship Of

Background and Objective. The posterior interosseous nerve (PIN) is vulnerable to injury in the dorsal approach to the proximal radius. The goal of this study is to describe the quantitative relationship of the PIN to the supinator muscle in the context of anatomic landmarks. Knowledge of superficial landmarks related to the PIN would hopefully minimize iatrogenic injury to the posterior interosseous nerve. Methods. 12 cadavers (22 forearms) were dissected and analyzed. The length of the supinator muscle was determined. The oblique distances of the PIN entry and exit points to the proximal and distal borders of the supinator muscle as well as their perpendicular distances to the lateral epicondyle-Lister’s tubercle (LE-LT) reference line were measured and recorded. The number of PIN branches inside the supinator substance was recorded. Mean and median values were determined and subjected to statistical analysis. Results. Mean supinator length was 5 centimeters. Ninety-one percent of the cadaveric forearms had PIN branches inside the supinator muscle substance. Twelve of the 22 forearms (55%) had 2 branches. The mean oblique distances of the PIN from the lateral epicondyle to the entry and exit points in the proximal and distal borders of the supinator muscle was 3.52 and 7.31 centimeters, respectively. The mean perpendicular distances of the PIN from LE-LT reference line to the entry and exit points in the proximal and distal borders of the supinator muscle was 1.13 and 1.26 centimeters, respectively. An imaginary danger-zone 4 centimeters wide overlying the LE-LT reference line depicts the possible area where the PIN and its branches may most likely be located. Conclusion. The dorsal approach to the proximal radius may allow a safe exposure without causing iatrogenic injury to the posterior interosseous nerve through the use of superficial anatomic landmarks and reference lines in combination with mean measurements from our study. Key

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