Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: A magnetic resonance imaging analysis

Placing K-wires obliquely through the anterior ulnar cortex is a common modification of traditional olecranon tension-band wiring. Wire tip protrusion, however, risks injury to adjacent neurovascular structures and may impede forearm rotation. This study examines the proximity of neurovascular struc...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2008, Vol.17 (1), p.121-125
Main Authors: Prayson, Michael J., MD, Iossi, Michael F., MD, Buchalter, David, MD, Vogt, Molly, PhD, Towers, Jeffrey, MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bone Wires
Elbow - anatomy & histology
Elbow - injuries
Elbow - innervation
Elbow Joint - anatomy & histology
Elbow Joint - innervation
Fractures, Bone - surgery
Humans
Injuries of the limb. Injuries of the spine
Magnetic Resonance Imaging
Median Nerve - anatomy & histology
Medical sciences
Orthopedic surgery
Orthopedics
Radial Artery - anatomy & histology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Traumas. Diseases due to physical agents
Ulna - anatomy & histology
Ulnar Nerve - anatomy & histology
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Summary:Placing K-wires obliquely through the anterior ulnar cortex is a common modification of traditional olecranon tension-band wiring. Wire tip protrusion, however, risks injury to adjacent neurovascular structures and may impede forearm rotation. This study examines the proximity of neurovascular structures to the anterior proximal ulnar cortex. The anatomy of 47 adult elbows was examined through magnetic resonance imaging. A radiologist measured the spatial relationship of 6 neurovascular structures to a mid-sagittal reference point 1.5 cm distal to the coronoid on the anterior surface of the ulna. Distance and angular measurements were made in the transverse plane of the reference point. Within a reasonable arc of K-wire placement, the ulnar artery and median nerve were at greatest risk yet were still beyond 10 mm from the anterior ulnar cortex. To avoid iatrogenic neurovascular injury during tension-band wiring of the olecranon, protrusion of wire tips beyond the anterior ulnar cortex should be no more than 1 cm at a distance of 1.5 cm distal to the coronoid.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2007.04.010