Echography-Guided Pinning for Prevention of Iatrogenic Injuries to the Radial Nerve during Fixation of Extra-articular Distal Radius Fracture: An Anatomical Study

This study assesses the usefulness and feasibility of an osteosynthesis of the lower end of the radius under ultrasound imaging to avoid the superficial branch of the radial nerve (SBRN). A single operator performed an initial echography of the wrist of 12 cadaveric upper limbs to identify the three main branches of the SBRN and the tendons. Then, three pins were placed according to Kapandji's procedure, avoiding the structures spotted under ultrasound imaging. After dissection, the safety distances for the branches of the SBRN, dorsal extensor tendons, and veins were measured, and injuries to these structures were noted. No lesion of the SBRN was found with an average safety distance of 8.1 for the third branch of the radial nerve (SR3) and 1.3 mm for the first and the second branches of the radial nerve (SR1-2). Three tendons were spiked. The average operative time was 38.3 minutes. Ultrasound secures percutaneous surgery to avoid the branches of the SBRN but requires a learning curve.