Location of the posterior interosseous nerve in relation to common lateral approaches to the elbow

Julie Chan; Ahmed A Habis; Essam Alzaben; Ryan T Bicknell; Parham Daneshvar

doi:10.1016/j.jse.2023.08.019

Location of the posterior interosseous nerve in relation to common lateral approaches to the elbow

J Shoulder Elbow Surg. 2024 Feb;33(2):381-388. doi: 10.1016/j.jse.2023.08.019. Epub 2023 Sep 27.

Authors

Julie Chan¹, Ahmed A Habis², Essam Alzaben³, Ryan T Bicknell⁴, Parham Daneshvar⁵

Affiliations

¹ Department of Surgery, Queen's University, Kingston, ON, Canada. Electronic address: 0jmtc@queensu.ca.
² Department of Surgery, Queen's University, Kingston, ON, Canada; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
³ Department of Surgery, Queen's University, Kingston, ON, Canada; Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
⁴ Department of Surgery, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
⁵ Department of Surgery, Queen's University, Kingston, ON, Canada.

PMID: 37774835
DOI: 10.1016/j.jse.2023.08.019

Abstract

Purpose: The risk of posterior interosseous nerve (PIN) injury during surgical approaches to the lateral elbow varies depending on the chosen approach, level of dissection, and rotational position of the forearm. Previous studies evaluated the trajectory of the PIN in specific surgical applications to reduce iatrogenic nerve injuries. The goal of this study is to examine the location of the PIN using common lateral approaches with varying forearm rotation.

Methods: The Kaplan, extensor digitorum communis (EDC) split, and Kocher approaches were performed on 18 cadaveric upper extremity specimens. Measurements were recorded with a digital caliper from the radiocapitellar (RC) joint and the lateral epicondyle to the point where the PIN crosses the approach in full supination, neutral, and full pronation with the elbow at 90°. The ratio of the nerve's location in relation to the entire length of the radius was also evaluated to account for different-sized specimens.

Results: The PIN was not encountered in the Kocher interval. For Kaplan and EDC split, with the forearm in full supination, the mean distance from the lateral epicondyle to the PIN was 52.0 ± 6.1 mm and 59.1 ± 5.5 mm, respectively, and the mean distance from the RC joint to the PIN was 34.7 ± 5.5 mm and 39.3 ± 4.7 mm, respectively; with the forearm in full pronation, the mean distance from the lateral epicondyle to the PIN was 63.3 ± 9.7 mm and 71.4 ± 8.3 mm, respectively, and the mean distance from the RC joint to the PIN was 44.2 ± 7.7 mm and 51.1 ± 8.7 mm, respectively.

Conclusions: The PIN is closer to the lateral epicondyle and RC joint in the Kaplan than EDC split approach and is not encountered during the Kocher approach. The PIN was not encountered within 26 mm from the RC joint and 39 mm from the lateral epicondyle in any approach and forearm position and is generally safe from iatrogenic injury within these distances.

Keywords: EDC split approach; Kaplan approach; Lateral approaches to elbow; lateral epicondyle; posterior interosseous nerve; radiocapitellar joint.

MeSH terms

Elbow / surgery
Elbow Joint* / physiology
Elbow Joint* / surgery
Forearm / physiology
Humans
Iatrogenic Disease
Peripheral Nerve Injuries*
Radius / surgery