Flow-Through Arterialized Posterior Interosseous Nerve Grafts for Digital Neurovascular Bundle Defects: Anatomical Study

Abstract Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal. Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal. Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured. Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case. Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

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Arthroscopic ligamentoplasty (bone–tendon–tenodesis). A new surgical technique for scapholunate instability: preliminary cadaver study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411412868 ◽

2011 ◽

Vol 36 (8) ◽

pp. 682-689 ◽

Cited By ~ 20

Author(s):

F. Corella ◽

M. Del Cerro ◽

R. Larrainzar-Garijo ◽

T. Vázquez

Keyword(s):

Surgical Technique ◽

Tissue Injury ◽

Arthroscopic Surgery ◽

Anatomical Study ◽

Scar Tissue ◽

Cadaver Study ◽

Posterior Interosseous Nerve ◽

Anatomic Dissection ◽

New Surgical Technique

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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Resistant Tennis Elbow

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(84)90018-4 ◽

1984 ◽

Vol 9 (1) ◽

pp. 64-66 ◽

Cited By ~ 37

Author(s):

G. H. HEYSE-MOORE

Keyword(s):

Radial Nerve ◽

Tennis Elbow ◽

Anatomical Study ◽

Nerve Entrapment ◽

Posterior Interosseous Nerve ◽

Lateral Epicondyle ◽

Adjacent Structures ◽

Extensor Carpi Radialis ◽

Symptoms And Signs ◽

Results Of Surgery

Fifty cases of resistant tennis elbow were studied, thirty seven of these had been treated by lengthening the tendon of extensor carpi radialis brevis, and thirteen by decompression of the radial tunnel. The two groups were well matched in terms of age, sex and pre-operative symptoms and signs. It was found that the results of surgery were very similar in the two groups and this observation is explained by anatomical study showing that surgical division of the fibrous arch of the superficial leaf of supinator will relieve tension on the lateral epicondyle and its adjacent structures thus allowing relief of symptoms independently of radial or posterior interosseous nerve decompression. This elaborates previously published work showing that there is no clinical or electrical evidence of radial nerve entrapment in resistant tennis elbow.

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Transfer of supinator motor branches to the posterior interosseous nerve in C7–T1 brachial plexus palsy

Journal of Neurosurgery ◽

10.3171/2009.10.jns09854 ◽

2010 ◽

Vol 113 (1) ◽

pp. 129-132 ◽

Cited By ~ 37

Author(s):

Jayme Augusto Bertelli ◽

Marcos Flavio Ghizoni

Keyword(s):

Brachial Plexus ◽

Index Finger ◽

Motor Nerve ◽

Anatomical Study ◽

Nerve Transfer ◽

Posterior Interosseous Nerve ◽

Lateral Aspect ◽

Finger Extension ◽

Finger Flexion ◽

Finger Motion

Object In C7–T1 palsies of the brachial plexus, shoulder and elbow function are preserved, but finger motion is absent. Finger flexion has been reconstructed by tendon or nerve transfers. Finger extension has been restored ineffectively by attaching the extensor tendons to the distal aspect of the dorsal radius (termed tenodesis) or by tendon transfers. In these palsies, supinator muscle function is preserved, because innervation stems from the C-6 root. The feasibility of transferring supinator branches to the posterior interosseous nerve has been documented in a previous anatomical study. In this paper, the authors report the clinical results of supinator motor nerve transfer to the posterior interosseous nerve in 4 patients with a C7–T1 root lesion. Methods Four adult patients with C7–T1 root lesions underwent surgery between 5 and 7 months postinjury. The patients had preserved motion of the shoulder, elbow, and wrist, but they had complete palsy of finger motion. They underwent finger flexion reconstruction via transfer of the brachialis muscle, and finger and thumb extension were restored by transferring the supinator motor branches to the posterior interosseous nerve. This nerve transfer was performed through an incision over the proximal third of the radius. Dissection was carried out between the extensor carpi radialis brevis and the extensor digitorum communis. The patients were followed up as per regular protocol and underwent a final evaluation 12 months after surgery. To document the extent of recovery, the authors assessed the degree of active metacarpophalangeal joint extension of the long fingers. The thumb span was evaluated by measuring the distance between the thumb pulp and the lateral aspect of the index finger. Results Surgery to transfer the supinator motor branches to the posterior interosseous nerve was straightforward. Twelve months after surgery, all patients were capable of opening their hand and could fully extend their metacarpophalangeal joints. The distance of thumb abduction improved from 0 to 5 cm from the lateral aspect of the index finger. Conclusions Transferring supinator motor nerves directly to the posterior interosseous nerve is effective in at least partially restoring thumb and finger extension in patients with lower-type injuries of the brachial plexus.

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Posterior interosseous nerve: An anatomic study of potential nerve grafts

The Journal Of Hand Surgery ◽

10.1016/0363-5023(93)90331-v ◽

1993 ◽

Vol 18 (4) ◽

pp. 743-745 ◽

Cited By ~ 20

Author(s):

Peter M. Waters ◽

J. Theodore Schwartz

Keyword(s):

Posterior Interosseous Nerve ◽

Anatomic Study ◽

Nerve Grafts

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Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study

Joints ◽

10.1055/s-0037-1605388 ◽

2017 ◽

Vol 05 (03) ◽

pp. 147-151 ◽

Cited By ~ 6

Author(s):

Paolo Arrigoni ◽

Davide Cucchi ◽

Enrico Guerra ◽

Alessandro Marinelli ◽

Alessandra Menon ◽

...

Keyword(s):

Adipose Tissue ◽

Radial Head ◽

Anterior Part ◽

Thick Layer ◽

Anatomical Study ◽

Proximal Part ◽

Neutral Position ◽

Posterior Interosseous Nerve ◽

Elbow Arthroscopy ◽

Soft Tissue Dissection

Purpose The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements. Methods Five fresh frozen cadaver specimens were dissected under arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position. Conclusion This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN. Clinical Relevance Knowledge of PIN position in relation to the anterior elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during elbow arthroscopy.

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