Use of the Humeral Head as a Reference Point to Prevent Axillary Nerve Damage during Proximal Fixation of Humeral Fractures: An Anatomical and Radiographic Study

Theeuwes, Hilco P.; Potters, Jan Willem; Bessems, J. H. J. M.; Kerver, A. J. H.; Kleinrensink, G.J.

doi:10.5005/jp-journals-10080-1460

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Human cervical vagus nerves (n = 62) were dissected and collected from a total of 43 human cadavers in the dissection room of the Erasmus MC Rotterdam between October 2019 and December 2021. Cadavers had been standardly embalmed 24 to 72 h post-mortem with normal 4% formaldehyde fixation using the AnubiFiX prerinse method (Slieker et al, 2012;Theeuwes et al, 2020). Post-embalming time before extraction of the nerves varied between 3 and 54 months during which the cadavers were kept in containers with fenoxyethanol.…”

Section: Human Vagus Nervesmentioning

confidence: 99%

Sympathetic components in left and right human cervical vagus nerve: implications for vagus nerve stimulation

Ruigrok,

Mantel,

Orlandini

et al. 2023

Front. Neuroanat.

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Cervical vagus nerve stimulation is in a great variety of clinical situations indicated as a form of treatment. It is textbook knowledge that at the cervical level the vagus nerve contains many different fiber classes. Yet, recently, several reports have shown that this nerve also may contain an additional class of potentially noradrenergic fibers, suggested to denote efferent sympathetic fibers. As such, the nature and presence of these fibers should be considered when choosing a stimulation protocol. We have studied human vagus material extracted from dissection room cadavers in order to further confirm the presence of this class of fibers, to study their origin and direction within the nerve and to determine their distribution and variability between subjects and pairs of left and right nerves of the same individual. Sections were studied with immunohistochemical techniques using antibodies against tyrosine hydroxylase (TH: presumed to indicate noradrenergic fibers), myelin basic protein and neurofilament. Our results show that at least part of the TH-positive fibers derive from the superior cervical ganglion or sympathetic trunk, do not follow a cranial but take a peripheral course through the nerve. The portion of TH-positive fibers is highly variable between individuals but also between the left and right pairs of the same individual. TH-positive fibers can distribute and wander throughout the fascicles but maintain a generally clustered appearance. The fraction of TH-positive fibers generally diminishes in the left cervical vagus nerve when moving in a caudal direction but remains more constant in the right nerve. These results may help to determine optimal stimulation parameters for cervical vagus stimulation in clinical settings.

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Section: Human Vagus Nervesmentioning

confidence: 99%

Sympathetic components in left and right human cervical vagus nerve: implications for vagus nerve stimulation

Ruigrok,

Mantel,

Orlandini

et al. 2023

Front. Neuroanat.

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Which parameters are more reliable in proximal humerus surgery in terms of the axillary nerve?

2023

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Proximal humerus fractures are the most common upper extremity fractures and account for approximately 4 to 5% of all fractures. [1] Proximal humerus fractures can be treated conservatively, particularly in the elderly. [2,3] Surgical options come to the forefront in comminuted and unstable fractures. Transosseous suture fixation, closed reduction and percutaneous fixation, open reduction with conventional or locking plate fixation, locking intramedullary nail, hemi, and total shoulder arthroplasty is among the different surgical options for surgically planned proximal humerus fractures. [4] The use of plating systems in the treatment of proximal humerus fractures has become more common owing to the effectiveness of locked plate applications. [5,6] The axillary nerve arises from the posterior cord of the brachial plexus. The nerve passes the quadrilateral space posterolaterally at the lower Objectives: This study aims to examine the reliability of the old and new parameters in determining the axillary nerve safe area for surgical interventions in the proximal humerus by measuring the distances between the top of the humeral head, the top of the greater tuberosity, the base of the greater tuberosity, and the acromion and axillary nerve. Materials and methods:Between 2020 and 2022, a total of 52 shoulders of 26 fresh frozen male human cadavers (mean age: 46±25.5 years; range, 28 to 64 years), 26 right and 26 left were included. The deltopectoral approach was used. The intersection distances of the anterolateral end of the acromion, the top of the humeral head, the top of the tuberculum majus, and the base of the tuberculum majus with the N. axillaries were determined. All measurements were performed using the Microscribe ® G2X. Results:The mean distance from the top of the tuberculum majus to the axillary nerve (shown as "A") was measured as 4.36±0.17 cm and 4±0.21 cm on the right and left, respectively. The mean distance from the center of the base of the tuberculum majus to the axillary nerve (shown as "B") was measured as 1.27±0.18 cm and 1.24±0.11 cm on the right and left, respectively. The mean distance from the apex of the humeral head to the axillary nerve (shown as "C") was measured as 6.15±0.39 cm and 5.89±0.34 cm on the right and left, respectively. The mean distance between the anterolateral end of the acromion (shown as "D") was measured as 6.15±0.39 cm and 5.89±0.34 cm on the right and left, respectively. There was a moderate positive correlation between distances A and B measured on the right and left side, respectively (r=0,484; p=0,012) (r=0,454; p=0,020). Conclusion:A strong positive correlation was found between the distances A and B. The A, B, and C parameters had a weak correlation with parameter D. The anatomical parameters A and B was found to be less variable and more reliable than parameter D.

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Risk of Axillary Nerve Injury With Medial Support Screws in Intramedullary Nails: An Anatomical Study

Kobayashi,

Miyake,

Shibata

et al. 2024

Cureus

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Background: In recent years, intramedullary nails with medial support screws for proximal humeral fractures have become available. Although these devices have a potential risk of iatrogenic axillary nerve injury, no studies have investigated the anatomical relationship between the medial support screws in the modern intramedullary nail and the axillary nerve. This study aimed to clarify the anatomical relationship between the medial support screws in the intramedullary nail and the axillary nerve. Materials and methods: In total, 29 cadaveric shoulders (mean age: 82.6 years old (range: 61-105); 15 males and 14 females) were included in this study. Shoulders within whole-body cadavers were used in all cases. A single proximal humeral nail with medial support screws (ARISTO Proximal Humeral Nail; MDM, Tokyo, Japan) was used. The distance of each medial support screw from the axillary nerve and its branches was measured. Results: In two (6.90%) of 29 shoulders, the axillary nerves came into contact with the medial support screws. In the remaining 27 of 29 shoulders (93.1%), the nerves were located proximal to the medial support screws. Conclusion: Medial support screws in proximal humeral fracture nails had the potential to injure the axillary nerve and its branches.

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Use of the Humeral Head as a Reference Point to Prevent Axillary Nerve Damage during Proximal Fixation of Humeral Fractures: An Anatomical and Radiographic Study

Cited by 3 publications

References 28 publications

Sympathetic components in left and right human cervical vagus nerve: implications for vagus nerve stimulation

Sympathetic components in left and right human cervical vagus nerve: implications for vagus nerve stimulation

Which parameters are more reliable in proximal humerus surgery in terms of the axillary nerve?

Risk of Axillary Nerve Injury With Medial Support Screws in Intramedullary Nails: An Anatomical Study

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