Anatomical base and clinical application of radial nervetransfer on internal fixation of fracture of middle and distal humerus

Objective:Through the anatomic observation and measurement on middle and distal humerus and radial nerve,of the design of nerve transposition to avoid radial nerve injury in the first and second surgery.Methods:By means of anatomic methods,radial nerve route and branches,and the relationship between radial nerve and deep brachial vessel of 30 upper limbs in 15 adult bodies fixed with 10% formalin were observed and measured.Meanwhile,the anatomical structures of 100 humeral specimens were also observed including length of humerus and radial groove,angle of radial nerve courser(included angle between radial groove and longitudinal axis of humerus).After statistical treatment these datas were used to design and apply in radial nerve transposition.Results: ①The length of humerus:the mean of left side was (30.60±1.46) cm (27.80-33.00 cm) and the right side (31.38±1.23) cm (29.20-33.70 cm).The length of radial groove:the mean of left side was (56.52±10.13) mm (43.82-75.68 mm) and the right side (65.74±5.80) mm (55.42-78.82 mm).The angle of radial nerve route:the mean of left side was (13.00±1.08)°(10.00°-13.50°) and the right side (13.86±0.97)°(10.50°-14.50°).②The angle of radial nerve route was from mediosupper of the radial groove oblique to lateroinferion,through intermuscular septum to mediosupper forming inward exoteric obtuse angle.The angle was obvious in 29 sides,that was 96.67%,and not obvious only in 1 side,that was 3.33%.③The position of the radial nerve divided into superficial and deep branches: 17 sides (56.76%) above the interepicondylar line and 10 sides (33.33%) below the line and 3 sides (10.00%) on the line .④The mean distance between the exit of radial nerve and the branches was (14.26±1.01) cm (12.80-19.20 cm).⑤The relationship between radial nerve and deep brachial vessel: radial nerve positioned medial to the deep brachial vessel in 12 sides,lateral to deep brachial vessel in 10 sides and radial nerve crossed the deep brachial vessel in 8 sides.⑥The outcome was satisfactory for 56 patients performed this operation.The fractures healed completely and there was no complication.Conclusion:The design of radial nerve transposition is reasonable,conforms to the radial nerve anatomy and physiology and provides much wider operation space for various kinds of internal fixation of fractures of middle and distal humerus.It can reduce the injury of the radial nerve in the course of the first operation and the second operation,moreover,operative difficulty and injury is not increased,It is an ideal technique.