Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study
Background: Safety zones to avoid nerve injury at proximal incision of posterior minimally invasive plate osteosynthesis for humerus fracture have been scarcely studied. The purpose of this study was to describe the location of axillary and radial nerves (RN) in magnetic resonance imaging to establi...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638322001700 |
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| author | Julio J. Contreras, MD Arturo Meissner, MD Alfonso Valenzuela, MD Rodrigo Liendo, MD Rodrigo de Marinis, MD Claudio Calvo, MD Francisco Soza, MD |
| author_facet | Julio J. Contreras, MD Arturo Meissner, MD Alfonso Valenzuela, MD Rodrigo Liendo, MD Rodrigo de Marinis, MD Claudio Calvo, MD Francisco Soza, MD |
| author_sort | Julio J. Contreras, MD |
| collection | DOAJ |
| description | Background: Safety zones to avoid nerve injury at proximal incision of posterior minimally invasive plate osteosynthesis for humerus fracture have been scarcely studied. The purpose of this study was to describe the location of axillary and radial nerves (RN) in magnetic resonance imaging to establish safety zones. Methods: Fifty-two magnetic resonance imaging studies of the entire humerus were reviewed. The mean age was 50.6 ± 12.1 years, with 37 female patients. The distance of the axillary nerve (AN; distal portion, humeral midpoint) and RN (medial border, midpoint, and lateral border of the humerus) was measured in relation to the posterolateral acromion angle, acromioclavicular axis, and transepicondylar axis. Univariate analysis (Student’s t test) and a multivariate analysis (linear regression) were performed. P values < .05 were considered significant. Results: The AN location at the humerus was 54.9 ± 6.4 mm (20.1% humeral length [HL]) in relation to posterolateral acromion angle and 63.2 ± 6.1 mm (23.2% HL) in relation to acromioclavicular axis. The RN location was 100.2 ± 17.1 mm (36.6% HL) at the humerus medial border, 118.0 ± 21.5 mm (43.1% HL) at the humerus midpoint, and 146.0 ± 24.4 mm (53.6% HL) at the humerus lateral border. In relation to transepicondylar axis, it was 175.4 ± 15.6 mm (64.3% HL), 156.0 ± 19.0 mm (57.2% HL), and 127.4 ± 21.2 mm (46.7% HL), respectively. Nerves location was related to HL, independent of gender. Conclusion: The main finding of our study is that the location of the AN and RN in relation to the humerus is related to the HL and can be used to predictably define the safe zones to avoid nerve injury in the proximal incision of posterior minimally invasive plate osteosynthesis for humerus fractures. |
| first_indexed | 2024-04-13T14:30:15Z |
| format | Article |
| id | doaj.art-1da3daf5162846af8c35c36d06d5ff94 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-04-13T14:30:15Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
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| series | JSES International |
| spelling | doaj.art-1da3daf5162846af8c35c36d06d5ff942022-12-22T02:43:12ZengElsevierJSES International2666-63832022-11-016610151022Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging studyJulio J. Contreras, MD0Arturo Meissner, MD1Alfonso Valenzuela, MD2Rodrigo Liendo, MD3Rodrigo de Marinis, MD4Claudio Calvo, MD5Francisco Soza, MD6Shoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile; Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile; Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile; Corresponding author: Julio J. Contreras Fernández, MD, Pontifical Catholic University of Chile, Department of Orthopedics and Trauma, Universidad de Chile, Instituto TraumatológicoPocuro #2170, D63, Santiago (PC 7510664), Chile.Shoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileShoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileShoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileShoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileShoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileShoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile; Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, ChileBackground: Safety zones to avoid nerve injury at proximal incision of posterior minimally invasive plate osteosynthesis for humerus fracture have been scarcely studied. The purpose of this study was to describe the location of axillary and radial nerves (RN) in magnetic resonance imaging to establish safety zones. Methods: Fifty-two magnetic resonance imaging studies of the entire humerus were reviewed. The mean age was 50.6 ± 12.1 years, with 37 female patients. The distance of the axillary nerve (AN; distal portion, humeral midpoint) and RN (medial border, midpoint, and lateral border of the humerus) was measured in relation to the posterolateral acromion angle, acromioclavicular axis, and transepicondylar axis. Univariate analysis (Student’s t test) and a multivariate analysis (linear regression) were performed. P values < .05 were considered significant. Results: The AN location at the humerus was 54.9 ± 6.4 mm (20.1% humeral length [HL]) in relation to posterolateral acromion angle and 63.2 ± 6.1 mm (23.2% HL) in relation to acromioclavicular axis. The RN location was 100.2 ± 17.1 mm (36.6% HL) at the humerus medial border, 118.0 ± 21.5 mm (43.1% HL) at the humerus midpoint, and 146.0 ± 24.4 mm (53.6% HL) at the humerus lateral border. In relation to transepicondylar axis, it was 175.4 ± 15.6 mm (64.3% HL), 156.0 ± 19.0 mm (57.2% HL), and 127.4 ± 21.2 mm (46.7% HL), respectively. Nerves location was related to HL, independent of gender. Conclusion: The main finding of our study is that the location of the AN and RN in relation to the humerus is related to the HL and can be used to predictably define the safe zones to avoid nerve injury in the proximal incision of posterior minimally invasive plate osteosynthesis for humerus fractures.http://www.sciencedirect.com/science/article/pii/S2666638322001700Humerus fractureMinimally invasive plate osteosynthesisAxillary nerveRadial nerve |
| spellingShingle | Julio J. Contreras, MD Arturo Meissner, MD Alfonso Valenzuela, MD Rodrigo Liendo, MD Rodrigo de Marinis, MD Claudio Calvo, MD Francisco Soza, MD Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study JSES International Humerus fracture Minimally invasive plate osteosynthesis Axillary nerve Radial nerve |
| title | Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study |
| title_full | Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study |
| title_fullStr | Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study |
| title_full_unstemmed | Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study |
| title_short | Establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures: a magnetic resonance imaging study |
| title_sort | establishing safe zones to avoid nerve injury in the posterior minimally invasive plate osteosynthesis for humerus fractures a magnetic resonance imaging study |
| topic | Humerus fracture Minimally invasive plate osteosynthesis Axillary nerve Radial nerve |
| url | http://www.sciencedirect.com/science/article/pii/S2666638322001700 |
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