NDLI: Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis.

Please wait, while we are loading the content...

CORR Insights: Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: systematic review and pooled analysis.

Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?

The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability, and demands in opposition.

Letter to the editor: Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.

CORR Insights: Patient activity after TKA depends on patient-specific parameters.

Comorbidities in patients undergoing total knee arthroplasty: do they influence hospital costs and length of stay?

Subject-specific patterns of femur-labrum contact are complex and vary in asymptomatic hips and hips with femoroacetabular impingement.

CORR Insights: Time-dependent changes after latissimus dorsi transfer: tenodesis or tendon transfer?

Antirotation pins improve stability of the compress limb salvage implant: a biomechanical study.

Reply to the letter to the editor: effectiveness of sustained stretching of the inferior capsule in the management of a frozen shoulder.

CORR Insights: What is the effect of advanced age and comorbidity on postoperative morbidity and mortality after musculoskeletal tumor surgery?

Letter to the editor: Effectiveness of sustained stretching of the inferior capsule in the management of a frozen shoulder.

Does fluoroscopy improve acetabular component placement in total hip arthroplasty?

CORR Insights: an analysis of references used for the Orthopaedic In-Training Examination: what are their levels of evidence and journal impact factors?

The alpha defensin-1 biomarker assay can be used to evaluate the potentially infected total joint arthroplasty.

Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients.

Reply to the letter to the editor: Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.

Editorial comment: Award papers from Turkish Society of Orthopaedics and Traumatology 2013.

Editorial comment: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements.

Modern trunnions are more flexible: a mechanical analysis of THA taper designs.

The myths of femoroacetabular impingement.

Letter to the editor: Editorial: words hurt - avoiding dehumanizing language in orthopaedic research and practice.

CORR Insights: Comorbidities in patients undergoing total knee arthroplasty: do they influence hospital costs and length of stay?

Editor's Spotlight/Take 5: The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability, and demands in opposition.

CORR Insights: Subject-specific patterns of femur-labrum contact are complex and vary in asymptomatic hips and hips with femoroacetabular impingement.

Letter to the Editor: Can Internet information on vertebroplasty be a reliable means of patient self-education?

CORR curriculum - orthopaedic education: Faculty development begins at home.

Obituary: a remembrance of William Fisher Enneking MD (1926-2014).

Gendered innovations in orthopaedic science: From access to zygote: a gender and orthopaedics lexicon.

Art in science: the Gross Clinic by Thomas Eakins.

Giants in orthopaedic surgery: Robert Bruce Salter CC, MD, FRCSC.

Editorial: Thanks to our peer reviewers.

Year: 2014 Volume: 472 Issue: 11

Year: 2014 Volume: 472 Issue: 10

Year: 2014 Volume: 472 Issue: 9

Year: 2014 Volume: 472 Issue: 8

Year: 2014 Volume: 472 Issue: 7

Year: 2014 Volume: 472 Issue: 6

Year: 2014 Volume: 472 Issue: 5

Year: 2014 Volume: 472 Issue: 4

Year: 2014 Volume: 472 Issue: 3

Year: 2014 Volume: 472 Issue: 2

Year: 2014 Volume: 472 Issue: 1

Year: 2013 Volume: 471

Year: 2012 Volume: 470

Year: 2011 Volume: 469

Year: 2010 Volume: 468

Year: 2009 Volume: 467

Year: 2008 Volume: 466

Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Bloom, Tamir Zhao, Caixia Mehta, Alpesh Thakur, Uma Koerner, John Sabharwal, Sanjeev
Description	Author Affiliation: Bloom T ( Department of Orthopedics, Rutgers, New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ, 07103, USA, bloomta@rutgers.edu.)
Abstract	BACKGROUND: The radial nerve is at risk for iatrogenic injury during placement of pins, screws, or wires around the distal humerus. Unlike adults, detailed anatomic information about the relationship of the nerve to the distal humerus is lacking in children. QUESTION/PURPOSES: This study evaluates the relationship of the radial nerve to the distal humerus in a pediatric population on conventional MRI and proposes an anatomic safe zone using easily identifiable bony landmarks on an AP elbow radiograph. METHODS: To determine the course of the radial nerve at the lateral distal humerus, we reviewed 23 elbow radiographs and MRIs of 22 children (mean age, 9 ± 4 years; range, 3-12 years) obtained as part of their workup for various elbow conditions. We described a technique using distance ratios calculated as a percentage of the patient's own transepicondylar distance, defined as the distance measured between the apices of the medial and lateral epicondyles, on the AP elbow radiograph and the midcoronal MR image. The cross-reference tool on a Picture Archiving and Communication System was then used to identify axial MR image at the level where the transepicondylar distance was measured. On this axial image, a line was drawn connecting the medial and lateral epicondyles (the transepicondylar axis) and its midpoint was determined. The radial nerve angle was measured by a line from the radial nerve to the midpoint of the transepicondylar axis and a line along the lateral half of the transepicondylar axis. On this axial slice, the closest distance from the nerve to the underlying cortex of the distal humerus was measured. To further localize the nerve along the distal humerus, predetermined percentages of the transepicondylar distance were projected proximally from the level of the transepicondylar axis along the longitudinal axis of the humerus on the midcoronal MR image. At these designated heights, the corresponding axial MR image was identified using the cross-reference tool and the nerve was mapped in a similar fashion. We then proposed a simpler method using a best-fit line drawn along the lateral supracondylar ridge on the AP radiograph to define the safe zone for lateral pin entry. RESULTS: On axial MR images, the radial nerve was located in the anterolateral quadrant with a mean radial nerve angle of 54° (range, 35°-87) at 0% transepicondylar distance (23 MRIs), 41° (range, 24°-63°) at 50% transepicondylar distance (23 MRIs), and ≥ 10° at 75% transepicondylar distance (on the 13 MRIs that extended this far cephalad). The mean closest distance between the radial nerve and the underlying humeral cortex was 10 mm (range, 3-26 mm) at 0% transepicondylar distance and 7 mm (3-16 mm) at 50% transepicondylar distance. On the AP elbow radiograph, the height of the lateral supracondylar ridge, determined by a best-fit line drawn along the lateral cortex of the ridge, diverged from the most proximal extent of the ridge at a point located at 60% transepicondylar distance (range, 51%-76%). At the corresponding location on the axial MR image, the nerve was located anterolaterally with a mean radial nerve angle of 39° (range, 15°-61°) and a mean distance of 6 mm (range, 2-10 mm) from the underlying humerus. CONCLUSIONS: Our data suggest that percutaneous direct lateral entry Kirschner wires and half-pins can be safely inserted in the distal humerus in children along the transepicondylar axis, either at or slightly posterior to the lateral supracondylar ridge, when placed caudal to the point located where the lateral supracondylar ridge line diverges from the proximal extent of the supracondylar ridge on AP elbow radiograph.
File Format	HTM / HTML
ISSN	0009921X
e-ISSN	15281132
DOI	10.1007/s11999-014-3509-x
Journal	Clinical Orthopaedics and Related Researchtextregistered
Issue Number	12
Volume Number	472
Language	English
Publisher	Springer
Publisher Date	2014-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Orthopaedics Anatomic Landmarks Bone Nails Adverse Effects Humerus Pathology Surgery Iatrogenic Disease Magnetic Resonance Imaging Peripheral Nerve Injuries Prevention & Control Radial Nerve Anatomy & Histology Child, Preschool Image Interpretation, Computer-assisted Etiology Predictive Value Of Tests Injuries Radiography Retrospective Studies Risk Factors
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Safe Zone for Superolateral Entry Pin Into the Distal Humerus in Children: An MRI Analysis

Course of the radial nerve in relation to the center of rotation of the elbow--the need for a rational safe zone for lateral pin placement.

Anatomic relationship of the radial nerve to the elbow joint: clinical implications of safe pin placement.

Iatrogenic nerve injuries in the treatment of supracondylar humerus fractures: are we really just missing nerve injuries on preoperative examination?

Fracture of distal humerus: MIPO technique with visualization of the radial nerve

Can fluoroscopy-based computer navigation improve entry point selection for intramedullary nailing of femur fractures?

Supine Extensile Approach to the Anterolateral Humerus.

Radial nerve injuries.

Identification of the radial nerve during the posterior approach to the humerus: a cadaveric study.

Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis.

Similar Documents

Safe Zone for Superolateral Entry Pin Into the Distal Humerus in Children: An MRI Analysis

Course of the radial nerve in relation to the center of rotation of the elbow--the need for a rational safe zone for lateral pin placement.

Anatomic relationship of the radial nerve to the elbow joint: clinical implications of safe pin placement.

Iatrogenic nerve injuries in the treatment of supracondylar humerus fractures: are we really just missing nerve injuries on preoperative examination?

Fracture of distal humerus: MIPO technique with visualization of the radial nerve

Can fluoroscopy-based computer navigation improve entry point selection for intramedullary nailing of femur fractures?

Supine Extensile Approach to the Anterolateral Humerus.

Radial nerve injuries.

Identification of the radial nerve during the posterior approach to the humerus: a cadaveric study.

Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis.