Echography-Guided Pinning for Prevention of Iatrogenic Injuries to the Radial Nerve during Fixation of Extra-articular Distal Radius Fracture: An Anatomical Study

Abstract

This study assesses the usefulness and feasibility of an osteosynthesis of the lower end of the radius under ultrasound imaging to avoid the superficial branch of the radial nerve (SBRN). A single operator performed an initial echography of the wrist of 12 cadaveric upper limbs to identify the three main branches of the SBRN and the tendons. Then, three pins were placed according to Kapandji's procedure, avoiding the structures spotted under ultrasound imaging. After dissection, the safety distances for the branches of the SBRN, dorsal extensor tendons, and veins were measured, and injuries to these structures were noted. No lesion of the SBRN was found with an average safety distance of 8.1 for the third branch of the radial nerve (SR3) and 1.3 mm for the first and the second branches of the radial nerve (SR1–2). Three tendons were spiked. The average operative time was 38.3 minutes. Ultrasound secures percutaneous surgery to avoid the branches of the SBRN but requires a learning curve.

Keywords

surgical technique - ultrasound - radius - pin

• References

• 1 Kapandji A. [Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author's transl)] [in French]. Ann Chir 1976; 30 (11–12): 903-908
• 2 Gravier R, Flecher X, Parratte S, Rapaie P, Argenson JN. [Trans-styloid and intrafocal pinning for extra-articular extension fractures of the distal radius: prospective randomized postoperative comparison with simple intra-focal pinning] [in French]. Rev Chir Orthop Repar Appar Mot 2006; 92 (07) 657-662
• 3 Yammine K, Rafi SM, Furhad S. Tendon and neurovascular injuries of the distal radius after pinning with Kirschner wires: a meta-analysis of cadaveric studies. Clin Anat 2015; 28 (04) 545-550
• 4 Handoll HH, Vaghela MV, Madhok R. Percutaneous pinning for treating distal radial fractures in adults. Cochrane Database Syst Rev 2007; (03) CD006080 . Doi: 10.1002/14651858.CD006080.pub2
• 5 Steinberg BD, Plancher KD, Idler RS. Percutaneous Kirschner wire fixation through the snuff box: an anatomic study. J Hand Surg Am 1995; 20 (01) 57-62
• 6 Clancey GJ. Percutaneous Kirschner-wire fixation of Colles fractures. A prospective study of thirty cases. J Bone Joint Surg Am 1984; 66 (07) 1008-1014
• 7 Habernek H, Weinstabl R, Fialka C, Schmid L. Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations, technique, and results. J Trauma 1994; 36 (01) 83-88
• 8 Mah ET, Atkinson RN. Percutaneous Kirschner wire stabilisation following closed reduction of Colles' fractures. J Hand Surg [Br] 1992; 17 (01) 55-62
• 9 Schneiders W, Elenz J, Rehberg S. , et al. [Long-term results after Kirschner wire pinning of distal radius fractures] [in German]. Unfallchirurg 2012; 115 (01) 38-46
• 10 Singh S, Trikha P, Twyman R. Superficial radial nerve damage due to Kirschner wiring of the radius. Injury 2005; 36 (02) 330-332
• 11 Hochwald NL, Levine R, Tornetta III P. The risks of Kirschner wire placement in the distal radius: a comparison of techniques. J Hand Surg Am 1997; 22 (04) 580-584
• 12 Sulaiman S, Soames R, Lamb C. The sensory distribution in the dorsum of the hand: anatomical study with clinical implications. Surg Radiol Anat 2015; 37 (07) 779-785
• 13 Santoshi JA, Chaware PN, Pakhare AP, Rathinam BA. An anatomical study to demonstrate the proximity of Kirschner wires to structures at risk in percutaneous pinning of distal radius fractures. J Hand Microsurg 2015; 7 (01) 73-78
• 14 Tryfonidis M, Charalambous CP, Mills SP. , et al. Distal radial and ulnar landmarks used in percutaneous pin fixation: anatomical relationship to the superficial radial and ulnar nerves. Hand Surg 2010; 15 (03) 161-164