Anat Cell Biol.  2020 Jun;53(2):132-136. 10.5115/acb.20.075.

Identification of most consistent and reliable anatomical landmark to locate and protect radial nerve during posterior approach to humerus: a cadaveric study

• Patra A
• Chaudhary P
• Malhotra V
• Arora K

• KMID: 2503442
• DOI: http://doi.org/10.5115/acb.20.075

Abstract

The location of the radial nerve (RN) is described with various bony landmarks, but such may be disturbed in the setting of fracture and dislocation of bone. Alternative soft tissue landmarks would be helpful to locate the nerve in such setting. To recognize certain anatomic landmarks to identify, locate and protect RN from any iatrogenic injury during surgical intervention such as open reduction and internal fixation. Forty arms belonging to 20 adult cadavers were used for this study. We measured the distance of RN from the point of confluence of triceps aponeurosis (TA), tip of the acromion and tip of the lateral epicondyle along the long axis of the humerus. These distances were correlated with the upper arm length (UAL). The average UAL was 32.64±0.64 cm. The distance of the RN from the point of confluence of TA (tricepso-radial distance, TRD), tip of acromion (acromion-radial distance) and tip of lateral epicondyle of humerus (condylo-radial distance, CRD) was 3.59±0.16 cm, 14.27±0.59 cm, and 17.14±1.29 cm respectively. No correlation was found with UAL. Statistically, TRD showed the least variability and CRD showed maximum variability. The minimum TRD was found to be 3.00 cm. So this should be considered as the maximum permissible length of the triceps split. The point of confluence of the TA appears to be the most stable and reliable anatomic landmark for localization of the RN during the posterior approach to the humerus.

Keyword

Radial nerve; Humerus; Acromion; Aponeurosis; Anatomic landmarks

Figure

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  Fig. 1 Showing the point of intersection between the intramuscular (IM) septum (dotted line) with the triceps aponeurosis, labelled as ‘point of confluence’.

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  Fig. 2 Showing the measurement of TRD distance between the point of confluence of TA (A) and the point of intersection of RN within spiral groove along the posterior aspect of the mid axial humerus (B). RN, radial nerve; TA, triceps aponeurosis; TRD, tricepso-radial distance.

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  Fig. 3 Splitting of triceps aponeurosis for better exposure of radial nerve. The nerve can seen overlying the periosteum of the humerus and within the spiral groove.

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  Fig. 4 Scatter plot showing distribution of measured parameters. ARD, acromion-radial distance; CRD, condylo-radial distance; TRD, tricepso-radial distance.

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