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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015)

20.10. - 23.10.2015, Berlin

Denervation of the posterior interosseous nerve through a volar approach. A new technique with anatomical considerations

Meeting Abstract

  • presenting/speaker Stephan Grechenig - Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
  • Michael Nerlich - Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
  • Manuel Dreu - Anatomie Graz, Graz, Austria
  • Claudia Dolcet - Anatomie Graz, Graz, Austria
  • Boyko Gueorguiev - AO Research Instiut, Davos, Switzerland
  • Arne Berner - Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
  • Markus Loibl - Universitätsklinikum Regensburg, Abteilung für Unfallchirurgie, Regensburg, Germany
  • Surjit Lidder - Royal College of Surgeons of England, London, United Kingdom

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015). Berlin, 20.-23.10.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocPO18-160

doi: 10.3205/15dkou659, urn:nbn:de:0183-15dkou6595

Veröffentlicht: 5. Oktober 2015

© 2015 Grechenig et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Chronic wrist pain following conditions such as degenerative arthritis, Kienbock's disease or scaphoid non-unions can be treated by denervation of the wrist. This is performed by transection of the anterior (AIN) and posterior interosseous nerves (PIN) either through multiple incisions 1 or a single dorsal incision 2. The technique is useful in providing sufficient pain relief 3 to markedly delay 4 a more extensive salvage procedure.

We hypothesized that the posterior interosseous nerve could be denervated through a volar approach to the wrist. This has previously not been described. This technique could be useful in ameliorating symptoms associated with the operative fixation of severely comminuted distal radius fractures

Methods: Twenty adult cadaveric upper limbs embalmed with the method of Thiel 5 were used. The course of the anterior and posterior interosseous nerves and interosseous artery were identified. Measurements were taken of these structures from the ulna border of the radius with the forearm in full supination at a level of 6cm, 8cm and 10cm proximal from the radial styloid. The proximal edge of the pronator quadratus muscle was measured as it crossed the interosseous membrane.

To assess whether the PIN could be transected via a single volar incision, a volar approach to the wrist was performed on a further 20 cadaveric upper limbs. The interosseous membrane was incised 1 cm proximal to the pronator quadratus muscle in line with the fibres of the interosseous membrane with the AIN and interosseous artery protected. A futher dorsal approach to the wrist was performed to identify the success rate in PIN transection.

Results: The AIN courses the interosseous membrane 7.5 mm (SD 2.4) at 6cm, 7.3 mm (SD 1.95) at 8 cm and 2.35 mm (3.42) at 10cm proximal to the radial styloid. The PIN courses the interosseous membrane 6.4 mm (SD 2.66) at 6cm, 8.4 mm (SD 2.28) at 8 cm and 3.75 mm (SD 5.46) at 10cm proximal to the radial styloid. The proximal edge of the pronator quadratus muscle crossing the interosseous membrane is 6.67 mm (SD 0.92) from the radial styloid.

Typically the interosseous artery crossed from an ulna to radial direction 13 cm (SD 1.5) in 10 specimens, 11.7 cm (SD 2.34) in 4 specimens proximal to the radial styloid and remained on the radial side in relation to the AIN in the remaining 6 specimens.

Transection of the PIN via a volar approach to the wrist was successful in 18 out of 20 forearms studies. The PIN could not be identified in two.

Conclusion: During the operative fixation of the distal radius, partial indirect wrist denervation is performed of the anterior interosseous nerve when the pronator quadratus muscle is incised distally and reflected to allow osthosynthesis. In this study we show that the posterior interosseous nerve can also be denervated through a volar approach to the wrist.

References