Variations in the Anatomic Relations of the Posterior Interosseous Nerve Associated with Proximal Forearm Trauma

Calfee, Ryan P.; Wilson, Joyce M.; Wong, Ambrose H. W.
January 2011
Journal of Bone & Joint Surgery, American Volume;1/5/2011, Vol. 93-A Issue 1, p81
Academic Journal
Background: The posterior interosseous nerve is at risk for iatrogenic injury during surgery involving the proximal aspect of the radius. Anatomic relationships of this nerve in skeletally intact cadavers have been defined, but variations associated with osseous and soft-tissue trauma have not been examined. This study quantifies the effect of a simulated diaphyseal fracture of the proximal aspect of the radius and of a radial neck fracture with an Essex-Lopresti injury on the posterior interosseous nerve. Methods: In twenty unembalmed cadaveric upper extremities, the distance from the radiocapitellar joint to the point where the posterior interosseous nerve crosses the midpoint of the axis of the radius (Thompson approach) was recorded in three forearm positions (supination, neutral, and pronation). Specimens were then treated with either proximal diaphyseal osteotomy (n = 10) or radial head excision with simulated Essex-Lopresti injury (n = 10), and the position of the nerve in each forearm position was remeasured. We evaluated the effect of the simulated trauma on nerve position and correlated baseline measurements with radial length. Results: In neutral rotation, the posterior interosseous nerve crossed the radius at a mean of 4.2 cm (range, 2.5 to 6.2 cm) distal to the radiocapitellarjoint. In pronation, the distance increased to 5.6cm (range, 3.1 to 7.4 cm) (p <0.01). Supination decreased that distance to 3.2 cm (range, 1.7 to 4.5 cm) (p < 0.01). Radial length correlated with each of these measurements (r> 0.50, p = 0.01). Diaphyseal osteotomy of the radius markedly decreased the effect of forearm rotation, as the change in nerve position from supination to pronation decreased from 2.13 ± 0.8cm to 0.24 ± 0.2 cm (p = 0.001). Proximal migration of the radius following radial head excision was accompanied by similar magnitudes of proximal nerve migration in all forearm positions. Conclusions: Forearm pronation has minimal effect on posterior interosseous nerve position within the surgical window following a displaced diaphyseal osteotomy of the proximal aspect of the radius. The nerve migrates proximally toward the capitellum with proximal migration of the radius in all forearm positions following a simulated Essex-Lopresti lesion. Visualization and protection of the posterior interosseous nerve is recommended when operatively exposing the traumatized proximal aspect of the radius.


Related Articles

  • FDA Under Pressure to Address Drug Safety Issues. Wechsler, Jill // BioPharm International;Feb2005, Vol. 18 Issue 2, p16 

    The article presents information on the growing alarm over harmful side effects from a number of popular prescription drugs is affecting a range of issues of critical importance for pharmaceutical and biotech manufacturers. The National Institutes of Health (NIH) has halted important clinical...

  • Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) grant impact on recipient academic career. Pryor, Aurora D.; Yurcisin, Basil M.; Bachman, Sharon; Madan, Atul; Stefanidis, Dimitrios; Torquati, Alfonso // Surgical Endoscopy;Jun2010, Vol. 24 Issue 6, p1468 

    Surgical societies, including SAGES, distribute grant funds to support research, as well as to promote recipient careers. Although we hypothesize that these awards have a positive impact, no objective evidence exists. We sought to benchmark the scientific productivity of the grants, the academic...

  • Courage and character, leaders and legends: an interview with Sir Roy Calne, FRS. Ohler, Linda // Progress in Transplantation;Sep2010, Vol. 20 Issue 3, p201 

    The author reflects on his interview with British transplant surgeon Sir Roy Calne during Calne's visit to the U.S. National Institutes of Health (NIH) Clinical Center to review the Center's research projects and discuss medical strategies for immunological tolerance of transplanted organs and...

  • BMI: the Weakness of a Milestone in Obesity Management and Treatment. Frattini, Francesco; Lavazza, Matteo; Rausei, Stefano; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo // Obesity Surgery;Oct2015, Vol. 25 Issue 10, p1940 

    The article discusses research concerning the use of body mass index (BMI) for eligibility to bariatric surgery in obese people. Topics discussed include guidelines by the U.S. National Institutes of Health (NIH) on using BMI for establishing eligibility to bariatric surgery, statement from the...

  • The North American view: the perspective of the American Association for Thoracic Surgeons†. Smith, Craig R. // European Journal of Cardio-Thoracic Surgery;Jan2013, Vol. 43 Issue 1, p244 

    The American Association for Thoracic Surgeons (AATS) is a small, selective organization focused on scholarship in thoracic surgery, complementing the Society of Thoracic Surgeon's focus on practice issues impacting all practicing surgeons. AATS works to improve the academic quality of North...

  • Recommendations for Treatment of Hospital-Acquired and Ventilator-Associated Pneumonia: Review of Recent International Guidelines. File, Jr., Thomas M. // Clinical Infectious Diseases;8/1/2010 Supplement 1, Vol. 51, pS42 

    Recently published guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia are reviewed for recommendations regarding diagnosis and antimicrobial therapy to assess the implications for development of future clinical trials. Despite some differences...

  • Most American Academy of Orthopaedic Surgeons' Online Patient Education Material Exceeds Average Patient Reading Level. Eltorai, Adam; Sharma, Pranav; Wang, Jing; Daniels, Alan // Clinical Orthopaedics & Related Research;Apr2015, Vol. 473 Issue 4, p1181 

    Background: Advancing health literacy has the potential to improve patient outcomes. The American Academy of Orthopaedic Surgeons' (AAOS) online patient education materials serve as a tool to improve health literacy for orthopaedic patients; however, it is unknown whether the materials currently...

  • Fracture Repair: Challenges, Opportunities, and Directions for Future Research. Einhorn, Thomas A.; Laurencin, Cato T.; Lyons, Karen // Journal of Bone & Joint Surgery, American Volume;Feb2008, Vol. 90-A Issue 2, p438 

    Information about the key discussion points of the 2007 American Academy of Orthopaedic Surgeons (AAOS) Research Symposium entitled "Fracture Repair: Challenges and Opportunities," is presented. Topics include identifying the unmet needs and research directions for basic, translational, and...

  • Incidental Adrenal Nodules and Masses: The Imaging Approach. Willatt, J.; Chong, S.; Ruma, J. A.; Kuriakose, J. // International Journal of Endocrinology;4/29/2015, Vol. 2015, p1 

    Adrenal nodules are detected with increasing frequency. The National Institute of Health (NIH), American College of Radiology (ACR), and the American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons (AACE/AAES) have produced guidelines for the management of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics