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Anatomic considerations regarding the posterior interosseous nerve at the elbow
Jeffrey N Lawton1, Michelle Cameron-Donaldson, Philip E Blazar
1The Curtis National Hand Center at Union Memorial Hospital, Baltimore, MD, USA. lawtonj@ccf.org
Journal of Shoulder and Elbow Surgery
|February 27, 2007
Summary
Surgeons should limit elbow dissection to 4.0 cm from the radiocapitellar joint (RCJ) to avoid posterior interosseous nerve (PIN) injury. Forearm rotation does not reliably increase the safe distance, emphasizing caution during lateral elbow surgery.
Area of Science:
- Anatomy
- Orthopedic Surgery
- Biomechanics
Background:
- The posterior interosseous nerve (PIN) is at risk during lateral elbow surgery.
- Understanding the PIN's relationship to the radius during forearm motion is crucial for surgical safety.
Purpose of the Study:
- To quantify the distance between the posterior interosseous nerve (PIN) and the radiocapitellar joint (RCJ) throughout forearm rotation.
- To establish a safe surgical zone for lateral elbow approaches to minimize PIN injury risk.
Main Methods:
- 24 cadaveric forearm specimens were analyzed.
- Measurements of the PIN to RCJ distance were taken in pronation, neutral, and supination.
- Variability in distance was assessed across different forearm positions.
Main Results:
- Mean PIN to RCJ distances were 5.7 cm (pronation), 5.3 cm (neutral), and 4.6 cm (supination).
- Significant variation was observed, with minimum distances of 4.3 cm (pronation) and 4.0 cm (supination).
- Pronation showed limited distal translation of the PIN.
Conclusions:
- A safe surgical zone of 4.0 cm from the RCJ is recommended for lateral elbow approaches, irrespective of forearm rotation.
- Formal identification of the PIN is advised due to variable positioning and limited distal translation in pronation.
- This contrasts with prior recommendations suggesting pronation increases the safe distance.
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