Risk of anterior interosseous nerve injury during forearm surgery: a cadaveric study.

IF 2.2 3区 医学 Q2 EMERGENCY MEDICINE
Arnaud Walch, Hugo Despert, Clément Jubelin, Laurent Mathieu, Camille Brenac, Thibault Druel
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Abstract

Purpose: The anterior interosseous nerve (AIN) is susceptible to injury during forearm surgery, particularly open reduction and internal fixation (ORIF) of radius fractures. This study aimed to analyze the anatomical relationships between the AIN and the radius to identify regions most vulnerable to iatrogenic injury.

Methods: A cadaveric study was conducted on ten fresh, non-embalmed forearms. Standardized dissections were performed to assess the course of the AIN, its motor branches, and their proximity to bony landmarks. Measurements were taken using a graduated ruler, with reference to the radius, the bi-epicondylar and bi-styloid lines.

Results: The AIN originated, on average, 13 mm from the radius, initially separated from the bone by the flexor digitorum profundus and flexor pollicis longus. The first branch to the flexor pollicis longus emerged at an average of 8 mm from the radius, marking the start of the nerve's close contact with the bone. The highest risk zone for AIN injury was identified at the junction of the proximal and middle thirds of the forearm.

Conclusion: The AIN and its motor branches exhibit significant anatomical variability but consistently demonstrate proximity to the radius at the proximal-middle third junction. To minimize iatrogenic injury, care should be taken when exposing the anterior radius, particularly by avoiding excessive traction or deep retractor placement in this region.

Abstract Image

Abstract Image

前臂手术中前骨间神经损伤的风险:一项尸体研究。
目的:在前臂手术中,尤其是桡骨骨折切开复位内固定(ORIF)手术中,前骨间神经(AIN)易受损伤。本研究旨在分析AIN和桡骨之间的解剖关系,以确定最容易受到医源性损伤的区域。方法:对10例新鲜、非防腐前臂进行尸体研究。进行标准化解剖以评估AIN的病程,其运动分支及其与骨标志的接近程度。测量采用刻度尺,参考半径,双上髁和双茎突线。结果:AIN起源于距桡骨平均13mm处,最初由指深屈肌和拇长屈肌与骨分离。长拇屈肌的第一个分支在距桡骨平均8毫米处出现,标志着神经开始与骨紧密接触。在前臂近端和中三分之一的交界处确定了AIN损伤的最高危险区。结论:AIN及其运动分支具有显著的解剖变异性,但始终显示接近于桡骨近中第三交界处。为了减少医源性损伤,暴露前桡骨时应小心,特别是避免在该区域过度牵引或放置深部牵开器。
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来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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