Universität zu Köln

Cucchi, Davide ORCID: 0000-0001-6284-7977, Luceri, Francesco, Menon, Alessandra, Mueller, Lars Peter, Kabir, Koroush, Randelli, Pietro Simone, Arrigoni, Paolo and Wegmann, Kilian . Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint. Arch. Orthop. Trauma Surg.. NEW YORK: SPRINGER. ISSN 1434-3916

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Abstract

IntroductionPreventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation.Materials and methodsThe median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90 degrees flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination.ResultsThe distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position.ConclusionsThe ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches.Level of evidenceBasic Science Study.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Cucchi, Davide UNSPECIFIED orcid.org/0000-0001-6284-7977 UNSPECIFIED Luceri, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Menon, Alessandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Lars Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabir, Koroush UNSPECIFIED UNSPECIFIED UNSPECIFIED Randelli, Pietro Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Arrigoni, Paolo UNSPECIFIED UNSPECIFIED UNSPECIFIED Wegmann, Kilian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-585586
DOI:	10.1007/s00402-021-03753-y
Journal or Publication Title:	Arch. Orthop. Trauma Surg.
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1434-3916
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POSTERIOR INTEROSSEOUS NERVE; CORONOID PROCESS; COLLATERAL LIGAMENT; RADIAL NERVE; BONE-GRAFT; RECONSTRUCTION; ARTHROSCOPY; FIXATION; EXPOSURE; PORTALS Multiple languages Orthopedics; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58558