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J Hand Surg Am. 2015 Mar;40(3):534-6. doi: 10.1016/j.jhsa.2014.10.039. Epub 2014 Dec 13.

Proximity of the posterior interosseous nerve during cortical button guidewire placement for distal biceps tendon reattachment.

Author information

1
University of Utah Department of Orthopedic Surgery, Salt Lake City, UT.
2
University of Utah Department of Orthopedic Surgery, Salt Lake City, UT. Electronic address: Andrew.Tyser@hsc.utah.edu.

Abstract

PURPOSE:

To assess the distance between the posterior interosseous nerve (PIN) and a distally and ulnarly directed guide pin for placement of a cortical button to reattach a distal biceps tendon.

METHODS:

We used 10 fresh frozen cadaveric upper limbs without deformities and identified the PIN through a dorsal approach. We performed a single incision anterior surgical approach, detached the biceps tendon, and drilled a 1.6-mm K-wire from the base of the biceps tendon insertion in 3 different trajectories, sequentially, measuring the following drilling angles: 30° distal and 30° ulnar, 30° ulnar, and 30° distal. In each testing scenario, we measured the minimum distance in millimeters between the tip of the K-wire and the PIN using a digital caliper through the dorsal incision.

RESULTS:

The mean and median distances from the guide wire to the PIN in each testing trajectory were each significantly different from each other, with the 30° ulnar direction leading to the greatest distance from the nerve.

CONCLUSIONS:

We found that the 30° ulnar drilling direction resulted in a significantly greater distance from the guide wire to the PIN, in comparison with the distal-ulnar and the distal-only trajectories.

CLINICAL RELEVANCE:

This study helps define the safe trajectory for guide wire placement in bicortical fixation of distal biceps tendon injuries.

KEYWORDS:

Distal biceps repair; endobutton; posterior interossesous nerve

PMID:
25510155
DOI:
10.1016/j.jhsa.2014.10.039
[Indexed for MEDLINE]

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