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The Journal of Bone and Joint Surgery 82:809 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Anatomical Considerations Regarding the Posterior Interosseous Nerve During Posterolateral Approaches to the Proximal Part of the Radius*

Thomas Diliberti, M.D.{dagger}, Michael J. Botte, M.D.{ddagger} and Reid A. Abrams, M.D.§

Investigation performed at the Hand Surgery Service, Department of Orthopaedics, University of California, San Diego
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}411 North Washington, Suite 7000, Dallas, Texas 75246.
{ddagger}Scripps Clinic, 10666 North Torrey Pines Road, Mail Slot 116, La Jolla, California 92037.
§University of California, San Diego, 200 West Arbor Drive, Mail Code 8894, San Diego, California 92103.

Background: The purpose of our study was to quantify the dimensions of a surgically safe zone along the proximal part of the radius, from the posterolateral aspect.

Methods: The posterolateral approach between the anconeus and the extensor carpi ulnaris was performed in thirty-two cadaveric specimens, and the posterior interosseous nerve was exposed. Forearms were measured from the radial styloid process to the radiocapitellar joint. The distance from the capitellum to the point where the posterior interosseous nerve crossed the radial shaft and the angle between the nerve and the shaft were measured with forearms in pronation and supination.

Results: Pronation of the forearm allowed safe exposure of at least the proximal thirty-eight millimeters of the lateral aspect of the radius, with an average proximal safe zone of 52.0 ± 7.8 millimeters. Supination decreased this proximal safe zone to as little as twenty-two millimeters and an average of 33.4 ± 5.7 millimeters. The angle formed by the posterior interosseous nerve and the radial shaft in supination averaged 47.4 6.8 degrees; this decreased to 27.8 ± 6.7 degrees with pronation.

Conclusions: Approaching the lateral aspect of the proximal part of the radius is safest in pronation.


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