Minimally invasive approach to the radial nerve – A new technique

• Published in: Injury 2015-12, Vol.46 (12), p.2374-2378
• Main Authors: Matzi, V, Hörlesberger, N, Hohenberger, G.M, Rosenlechner, D, Dolcet, C, Weiglein, A.H, Maier, M.J, Grechenig, St
• Format: Article
• Language: English
• Subjects: Arm - anatomy & histology; Arm - innervation; Cadaver; Forearm - innervation; Fracture Fixation, Internal - education; Fracture Fixation, Internal - methods; Humans; Humerus - anatomy & histology; Humerus shaft; Minimally invasive plate osteosynthesis; Minimally Invasive Surgical Procedures; Muscle, Skeletal - anatomy & histology; Orthopedics; Posterior antebrachial cutaneous nerve; Practice Guidelines as Topic; Radial nerve; Radial Nerve - anatomy & histology
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2015.09.017

Abstract Purpose To describe a minimally invasive approach to find the radial nerve (RN) simply and safely by tracing the posterior antebrachial cutaneous nerve (PACN) without damaging muscles, using only the surgeon's hand to define a window for the skin incision. Background Although it is absolutely necessary to locate the radial nerve during osteosynthesis of the humerus, the literature lacks guidelines on how to do so. Methods We have dissected the upper extremities of 54 adult human cadavers, embalmed using Thiel's method. After the PACN was identified in a defined space, its course was traced proximally by incising the lateral intermuscular septum (LIS) of the upper arm and thereby reaching the radial nerve (RN). Subsequently, using the lateral epicondyle (LE) of the humerus as a reference point, the distances to the points where the PACN perforated the LIS, and where the RN was identified, were measured. These individual data were related to the total length of the humerus. Results The results indicate that with this approach and without harming musculature, the RN can be reached by tracing the PACN at a height of 11.1–13.0 cm (females) and 11.9–14.0 cm (males) starting from the LE. Conclusion Our examination shows the PACN to be a convenient guide to the RN.