The risk of iatrogenic radial nerve and/or profunda brachii artery injury in anterolateral humeral plating using a 4.5 mm narrow DCP: A cadaveric study

Abstract

Introduction

Fixation of humeral shaft fractures with a plate and screws can endanger the neurovascular structure if proper care is not taken. No studies to our knowledge have studied the risk of iatrogenic radial nerve and/or profunda brachii artery (RNPBA) injury from each screw hole of a 4.5 mm narrow dynamic compression plate (narrow DCP). The purpose of this study is to evaluate the risk of RNPBA injury in anterolateral humeral plating with a 4.5 mm narrow DCP.

Material and methods

18 humeri of 9 fresh-frozen cadavers in the supine position were exposed via the anterolateral approach with 45 degrees of arm abduction. A hypothetical fracture line was marked at the midpoint of each humerus. A precontoured ten-hole 4.5mm narrow DCP was applied to the anterolateral surface of the humerus using the fracture line to position the center of the plate. All screw holes were drilled and screws inserted. The cadaver was then turned over to the prone position with 45 degrees of arm abduction, and the RNPBA exposed. The holes through in which 100% of the screw had contact with or penetrated the RNPBA were identified as dangerous screw holes, while lesser percentages of contact were defined as risky.

Results

The relative distance ratios of the entire humeral length from the lateral epicondyle of the humerus to the 4 ^th, 3 ^rd, 2 ^nd and 1 ^st proximal holes were 0.64, 0.60, 0.56 and 0.52, respectively. The most dangerous screw hole was the 2 ^nd proximal, in which all 18 screws had contacted or penetrated the nerve, followed by the risky 1 ^st (12/18), 3 ^rd (8/18) and 4 ^th (2/18) holes.

Conclusion

In humeral shaft plating with the 4.5mm narrow DCP using the anterolateral approach, the 2 ^nd proximal screw hole carries the highest risk of iatrogenic radial nerve and/or profunda brachii artery injury.