scholarly journals Variation of the palmar cutaneous branch of the median nerve identified within the tendon sheath of the flexor carpal radialis

2022 ◽  
Author(s):  
Ha Sung Park ◽  
Shin Woo Choi ◽  
Joo-Yul Bae
Keyword(s):  
Median Nerve ◽  
Distal Radius ◽  
Plate Fixation ◽  
Tendon Sheath ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Specific Finding ◽  
Henry Approach

Purpose: During volar plate fixation of distal radius fractures, we have encountered patients with an anomalous course of the palmar cutaneous branch (PCB) of the median nerve within the sheath of the flexor carpi radialis (FCR) tendon. The purpose of this study was to assess the frequency and location of variations of the PCB within the sheath of the FCR tendon.Methods: This retrospective study enrolled 83 patients who underwent volar locking plate fixations through a modified Henry approach for distal radius fractures from July 2018 to April 2020. When we encountered an anomalous PCB within the sheath of the FCR tendon, we documented the specific finding and location where the PCB entered the sheath of the FCR tendon.Results: There were nine patients (10.8%) who had an anomalous course of PCB penetrating the sheath of the FCR tendon. The average entering point of PCB into the sheath of the FCR tendon was 3.07 cm from the distal wrist crease (range, 2.5–3.6 cm).Conclusion: An anomalous course of the PCB entering the sheath of the FCR tendon was observed at a high frequency (10.8%). Care must be taken not to injure the PCB during a dissecting of the FCR sheath during a modified Henry approach for a distal radius fracture.

scholarly journals Anomalous Courses of the Palmar Cutaneous Branch of the Median Nerve in Relation to the Flexor Carpi Radialis Tendon for ORIF of Distal Radius Fractures

Hand ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 521-525
Author(s):  
Steven Z. Glickel ◽  
Sara M. Glynn ◽  
Andy L. Chang ◽  
Jessie W. Janowski ◽  
O. Alton Barron ◽  
...  
Keyword(s):  
Median Nerve ◽  
Distal Radius ◽  
Tendon Sheath ◽  
Distal Radius Fractures ◽  
Final Decision ◽  
Radius Fractures ◽  
Flexor Carpi Radialis ◽  
Palmar Cutaneous Branch ◽  
Branching Patterns ◽  
Cutaneous Branch

Background: The purpose of this study was to prospectively document the incidence of variations in the course of palmar cutaneous branch of the median nerve (PCBMN) that may increase the risk of injury to the nerve during the flexor carpi radialis (FCR) approach. We hypothesize that the incidence of anomalous branching of the PCBMN around the FCR sheath will be approximately 5%. Methods: All cases that met inclusion criteria between November 2013 and March 2018 were included. The operating surgeon made the final decision for operative intervention using the FCR approach. Each surgeon performed the standard FCR approach to the distal radius. The branching location from the median nerve, the relationship to the FCR sheath, and the course of the PCBMN were recorded. Results: In total, 101 distal radius fractures were included. The average branching point of PCBMN was 5.2 cm from the distal wrist crease (range = 3.3-9.0). There were 26 anomalous branching patterns of PCBMN. Nineteen (18.8%) crossed volar, dorsal, or ran within the FCR sheath. Six PCBMN were found within the FCR sheath, 1 penetrated the FCR sheath, 6 crossed volar to the FCR sheath, and 6 were dorsal to the FCR tendon sheath. When comparing the branching patterns of the PCBMN from the median nerve, 4 branched from the volar aspect, 2 branched from the dorsal aspect, and 1 branched from the ulnar aspect of the median nerve. Conclusions: Variation in the course of the PCBMN relative to the FCR sheath is more than previously thought and can be expected in approximately 18.8% of patients.

scholarly journals Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

2011 ◽  
Vol 93 (1) ◽  
pp. 57-60 ◽  
Author(s):  
DC Perry ◽  
DMG Machin ◽  
JA Casaletto ◽  
DJ Brown
Keyword(s):  
High Risk ◽  
Distal Radius ◽  
Plate Fixation ◽  
Tendon Injury ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Extensor Pollicis Longus ◽  
Fixed Angle ◽  
Volar Plate Fixation

INTRODUCTION Rupture of extensor pollicis longus (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific ‘high-risk’ holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of ‘high-risk’ holes and appropriate minor alterations in surgical technique may consequently decrease the incidence of EPL irritation and rupture.

Plate Fixation of Distal Radius Fractures

Hand Clinics ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 259-266
Author(s):  
Lili E. Schindelar ◽  
Asif M. Ilyas
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

scholarly journals Volar Plate Fixation with AO Distal Radius Plate (DRP) for Distal Radius Fractures

2005 ◽  
Vol 54 (3) ◽  
pp. 611-616
Author(s):  
Kazunobu Arakaki ◽  
Hikaru Tashima ◽  
Yosuke Asahara ◽  
Chikara Deguchi ◽  
Futoshi Kuga
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Volar Plate Fixation

Utility and Cost Analysis of Radiographs Taken 2 Weeks Following Plate Fixation of Distal Radius Fractures

2015 ◽  
Vol 40 (6) ◽  
pp. 1106-1109 ◽  
Author(s):  
Jeffrey D. Stone ◽  
Lisa M. Vaccaro ◽  
R. Colin Brabender ◽  
Alfred V. Hess
Keyword(s):  
Cost Analysis ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

2018 ◽  
Vol 07 (05) ◽  
pp. 409-414
Author(s):  
J. Hill ◽  
Gabriel Bouz ◽  
Ali Azad ◽  
William Pannell ◽  
R. Alluri ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Outcome Measures ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Dash Score ◽  
Radius Fractures ◽  
Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

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