The location of the radial nerve in the humeral shaft between the prone and lateral decubitus positions with different elbow positions and its implications: A cadaveric study

Abstract

Identification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or lateral decubitus position depending on the surgeon’s preference. The distance from the radial nerve to the osseous structures will be different in each position. The purpose of this study was to identify the safety zones of the various patient and elbow flexion positions. The distances from the olecranon to the center of the radial groove and intermuscular septum and lateral epicondyle to the lateral intermuscular septum were measured using a digital Vernier caliper. The measurements were performed with the cadavers in the lateral decubitus and prone positions with different elbow flexions. The distance from where the radial nerve crossed the posterior aspect of the humerus measured from the upper part of the olecranon to the center of the radial nerve in both positions with different elbow flexion angles varied from a mean maximum distance of 130.00 mm with the elbow in full extension in the prone position to the shortest distance of 121.01 mm with elbow flexion of 120 degree in the lateral decubitus position. The mean distance of the radial nerve from the upper olecranon to the lateral intermuscular septum varied from 107.13 mm to 102.22 mm. The distance from the lateral epicondyle to the lateral edge of the radial nerve varied from 119.92 mm to 125.38 mm. There was very little change in the measurements and no important different distances of radial nerve location until the elbow was flexed to 120 degrees, which was not significant as this flexion is rarely used.

The risk of iatrogenic radial nerve and/or profunda brachii artery injury in anterolateral humeral plating using a 4.5 mm narrow DCP: A cadaveric study

“…Several studies have evaluated the anatomical location of the radial nerve in relation to different landmarks such as the olecranon process, lateral epicondyle, medial epicondyle, intermuscular septum and/or acromial process [ 8 , 29 – 31 ]. The study of Suwannaphisit et al found that the radial nerve passed the posterior humerus from 130.00 ± 2.07 mm between the upper olecranon and the center of the radial nerve to 122.00 ± 2.33 mm between the lateral epicondyle and the lateral intermuscular septum [ 30 ]. In another study, in relation to the epicondyle, the radial nerve passed the posteromedial-to-posterolateral aspect of the humerus between 152 mm and 66 mm from the medial epicondyle [ 8 ].…”

Frequency of Radial Nerve Injury in Patients With Closed Fracture of Humerus Shaft in High Energy Trauma Cases

“…Fracture of the humerus usually results in radial nerve injury, it is the most common injury in humerus fracture. 1,2 The reason for the injury of the radial nerve is due to its close anatomical position about the humerus. The radial nerve is the terminal continuation of the posterior cord of the brachial plexus it contains nerve roots from C5-T1.…”

Frequency of Radial Nerve Palsy in Patients with Closed Traumatic Humeral Shaft Fracture in High Energy Trauma Cases

“…It is the most common injury in humerus fractures. 1,2 The injury of the radial nerve is due to its close anatomical approximation to the humerus at this level. The radial nerve arises from the posterior cord of the brachial plexus' that comprises of nerve roots arising from the spinal cord from C5 to T1 levels.…”