Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study

Abstract

AIMTo determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).METHODSTwenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.RESULTSThis image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.CONCLUSIONCASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

One portal endoscopic release of the first extensor compartment in de Quervain's disease

“…Poublon et al. showed that, there is a large variation in the course of the superficial branch of the radial nerve over the first extensor compartment and no complete safe zone can be defined 23 . The endoscopic approach allows us to keep our incisions outside of the hypersensitized zone of injury 10 .…”

“…After branching proximal to the radial styloid, superficial radial nerve diverged from the first extensor compartment, whereas the lateral dorsal digital branch of the superficial radial nerve traversed parallel to the midline of the first extensor compartment radially 22 . The nerve density gradually decreases from proximal to distal of the first compartment and a safe zone is formed distal of the radial styloid 23 . For these reasons, we thought it would be safer to using a single portal distal to the radial styloid.…”

Safe approach for fixation of first metacarpal fractures: an anatomical study

“…CASAM enables comparison of anatomical routes and anatomical relationships between different specimens that that differ in size (Kerver et al., 2012, 2013; Poublon et al., 2018; Ten Berge et al., 2011). CASAM is based on the fact that bony landmarks, such as Lister’s tubercle, have a relatively constant position in each limb.…”

“…These photographs were made using a standardized set-up (Kerver et al., 2012). The camera was positioned perpendicular to the specimen at a fixed distance, and the limbs were placed in specially designed clamps to ensure standard alignment (Poublon et al., 2018). The photographs of each specimen were then used for CASAM.…”

“…Computer-assisted surgical anatomy mapping (CASAM) has been successfully used to define anatomical variance in a number of anatomical studies (Kerver et al., 2012, 2013; Ten Berge et al., 2011; van der Graaf et al., 2011). Based on these anatomical studies, important clinical recommendations help optimize surgical approaches (Kerver et al., 2013; Poublon et al., 2018). The current anatomical study uses CASAM to focus on the branching pattern of the SBRN and the DBRA in the area of the first and second metacarpals.…”