Avoiding radial nerve palsy in proximal radius shaft plating - a cadaver study

Area of Science:

• Orthopedic surgery
• Anatomy
• Nerve surgery

Background:

• Surgical approaches for radial nerve palsy, specifically Henry's and Thompson's, involve detaching the supinator muscle.
• The optimal forearm position for this detachment remains debated, impacting safety and proximity to the posterior interosseous nerve (PIN).

Purpose of the Study:

• To determine the ideal forearm rotation for safely detaching the supinator muscle during Henry's and Thompson's approaches.
• To elucidate the anatomical relationship between the supinator detachment site and the PIN.

Main Methods:

• Dissection of 90 upper extremities from Thiel-embalmed cadavers.
• Identification of the radial nerve and its course to the Arcade of Frohse (AF).
• Measurement of distances from the AF to the distal biceps tendon (DBT) and radiocapitellar joint space (RCJS) in pronation and supination.

Main Results:

• Distances between the AF and DBT were significantly shorter in pronation compared to supination.
• The interval between the AF and RCJS in supination correlated positively with radial length (RL).

Conclusions:

• Forearm supination is recommended for safe supinator detachment in Henry's and Thompson's approaches.
• This position provides a greater margin of safety relative to the PIN.