[An anatomic study of the superficial radial nerve and its clinical implications]

In hand surgery, the k-wires are used frequently and effectively. Several texts mention complications following surgery of the wrist and hand. A safe zone has been described by Steinberg et al., where 40 K-wires were placed in the anatomic snuffbox of 10 cadaveric forearms. The placement of the k-wires were evaluated radiologically and by dissection to examine the underlying structures. A branch of the superficial radial nerve (NRS) was injured in 22% (2/9) of the specimens and the cephalic vein in 33% (3/9). The radial artery was never injured but had a K-wires at least 1 mm away in 22% of the specimens. The anatomy and pattern of distribution of the NRS was studied and compared with the data found in the literature. The NRS emerged between the tendons the muscles of brachioradialis and extensor carpi radialis longus in 9 of 10 specimens, and at a mean distance of 7.8 cm from the radial styloid. The first and second division were at a mean distance proximal to the radial styloid of 4.5 and 3.0 cm, respectively. The mean number of branches of the NRS at the radial styloid was 5.1. Despite a relatively consistent anatomy of the NRS, the anatomic snuffbox remains a complex and dangerous area due to the variability of the nerve's anatomy. An open surgical approach is thus preferred to avoid traumatizing the nerves and vascular structures.