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Palaniappan G, Sathappan S, Veeraraghavalu A. Surgical importance of using musculo-aponeurotic landmarks as a guide to identify the radial nerve in posterior approach for humeral fractures a cadaveric study in a south indian population. Journal of Research in Applied and Basic Medical Sciences 2022; 8 (3) :150-160
URL: http://ijrabms.umsu.ac.ir/article-1-194-en.html
Assistant professor in Orthopaedics, K.A.P.V Government Medical College, Tiruchirappalli, Tamilnadu, India , siva.soundaram@gmail.com
Abstract:   (1157 Views)
Background & Aims:  Long course of the radial nerve and its proximity to the humerus makes Radial Nerve (RN) prone to injury in diaphyseal fractures. In an effort to maintain its integrity, soft tissue landmarks can be readily made use of to provide facile nerve identification, as osseous landmarks might get altered in fractures. The aim of this study was to provide an idea of safe zone for securing radial nerve in relation to soft tissue structures and thereby, preventing the concomitant iatrogenic injury.
Materials & Methods:  40 Upper limb specimens from 20 cadavers were dissected. The radial nerve was identified proximal to the apex of Tricipital aponeurosis (TA) in posterior arm, at the level of entry into the lateral inter muscular septum and along the lateral border of TA. The mean distance between the radial nerve and aponeurosis was measured at all the three sites to find the safe zone for securing the radial nerve during surgeries.
Results:  The radial nerve was found proximally from the medial apex of tricipital aponeurosis at a distance of 43.49 ± 6.67 mm (range 30.34-55.72 mm) within the muscle belly of triceps. The minimal permissible distance for the triceps split was 3.03 cm from the medial apex for both right and left arms. The distance of above 15 mm (range from 15.56 to 47.47mm) from the lateral border of tricipital aponeurosis was considered as a safe zone and no branches of the radial nerve were found in this zone. Radial nerve was identified along its course in the range of 15.56 to 47.47 mm from the lateral border of TA and this should be taken into consideration by the operating surgeon.
Conclusion:  The Tricipital aponeurosis is a useful soft tissue landmark to secure the radial nerve safely throughout its course in the arm. Knowledge of safe and dangerous zones of the radial nerve would help the orthopedic surgeons to avoid the risk of iatrogenic nerve injury, which is not an uncommon phenomenon.
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Type of Study: orginal article | Subject: Special

References
1. Standring S, editor. Gray's anatomy e-book: the anatomical basis of clinical practice. Elsevier Health Sciences; 2021. P. 581-8 [URL]
2. Dutta AK. Essentials of Human Anatomy. 5th ed. 2010. P. 106-7 [URL]
3. Theeuwes HP, van der Ende B, Potters JW, Kerver AJ, Bessems JH, Kleinrensink GJ. The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment. PLoS One 2017;12(10):e0186890. [DOI:10.1371/journal.pone.0186890] [PMID] [PMCID]
4. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. 2005. Radial nerve palsy associated with fractures of the shaft of the humerus: A systematic review. J Bone Joint Surg Br 87:1647-52. [DOI:10.1302/0301-620X.87B12.16132] [PMID]
5. Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome. J Orthop Trauma 2008;22(10):693-7. [DOI:10.1097/BOT.0b013e31818915bf] [PMID]
6. Ahad A, Haque A, Armstrong A, Modi A, Pandey R, Singh HP. The management of displaced humeral shaft fractures-A survey of UK shoulder and elbow surgeons. Shoulder Elbow 2021:1758573220986940. [DOI:10.1177/1758573220986940] [PMID]
7. McCann PA, Smith GC, Clark D, Amirfeyz R. The tricipital aponeurosis-a reliable soft tissue landmark for humeral plating. Hand Surg 2015;20(1):53-8. [DOI:10.1142/S0218810415500070] [PMID]
8. Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop Relat Res 1995;320:149-53. [DOI:10.1097/00003086-199511000-00025]
9. 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(11):1690-5. [DOI:10.2106/00004623-199611000-00008] [PMID]
10. Carlan D, Pratt J, Patterson JM et al. The radial nerve in the brachium: An anatomic study in human cadavers, J Hand Surg 2007;32:1177-82. [DOI:10.1016/j.jhsa.2006.07.001] [PMID]
11. 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. [DOI:10.1002/ca.20831] [PMID]
12. 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. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clin Anat 2004;17(1):26-9. [DOI:10.1002/ca.10181] [PMID]
13. Chaudhry T, Noor S, Maher B, Bridger J. The surgical anatomy of the radial nerve and the triceps aponeurosis. Clin Anat 2010;23(2):222-6. [DOI:10.1002/ca.20903] [PMID]
14. Arora S, Goel N, Cheema GS et al. A method to localize the radial nerve using the 'apex of triceps aponeurosis' as a landmark. Clin Orthop Relat Res 2011;469(9):2638-44. [DOI:10.1007/s11999-011-1791-4] [PMID] [PMCID]
15. Athwal GS, Hoxie SC, Rispoli DM et al. Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma 2009 23:575-80. [DOI:10.1097/BOT.0b013e3181aa5402] [PMID]
16. Seigerman DA, Choung EW, Yoon RS, Lu M, Frank MA, Gaines LRJ, et al. Identification of the radial nerve during the posterior approach to the humerus: a cadaveric study. J Orthop Trauma 2012;26(4):226-8 [DOI:10.1097/BOT.0b013e31821d0200] [PMID]
17. Chou PH, Shyu JF, Ma HL et al. Courses of the radial nerve differ between Chinese and Caucasians: Clinical applications. 2008 Jan;466(1):135-8 [DOI:10.1007/s11999-007-0019-0] [PMID] [PMCID]
18. Patra A, Chaudhary P, Arora K, Ravi KS. Surgical anatomy of the radial nerve in the anterior compartment of the arm: relationship with the triceps aponeurosis. Surg Radiol Anat 2021 May;43(5):689-94. [DOI:10.1007/s00276-021-02683-z] [PMID]
19. Prasad M, Isaac B, Premkumar PS. Anatomic Landmarks to Identify the Radial Nerve during the Posterior Approach of the Humerus: A Cadaveric Study. J Clin Diagn Res 2018 Nov 1;12(11):1-4. [DOI:10.7860/JCDR/2018/37922.12275]

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