Prediction of the location of radial nerve in arm to avoid iatrogenic injury: Cadaveric study in Indian population

Abstract

Background: The radial nerve arises from posterior cord of brachial plexus and descends distally to spiral groove, our aim is to study upper and lower margins of groove with respect of bony landmark like posterolateral aspect of Acromian process, medial and lateral epicondyle of humerus, which helps to identify radial nerve during humerus fracture fixation surgery and hence will reduce iatrogenic radial nerve injury.Methods: Twenty formalin preserved cadaveric upper limbs obtained from anatomy department of Government medial collage, Surat. Dissection done, Radial nerve isolated from low triangular space to lateral inter muscular septum and various measurements done for each specimen.Result: Without sex or age differentiation the results of this study are: The mean humeral length was 30.6 ± 1.86 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.3±1.48 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.49±1.46 cm. The mean length of radial nerve groove/spiral groove was 4.29±1.28 cm.Conclusion: Radial nerve is at the risk of injury with fracture & fixation in two areas. First along the spiral groove & second along the lateral aspect of humerus in distal third from proximal to lateral epicondyle to level of proximal aspect of metaphyseal flare. Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and zone of danger of humerus provide more safety during surgical interference of humerus. To do this, radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.