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

PLoS One. 2021 Nov 30;16(11):e0260448. doi: 10.1371/journal.pone.0260448. eCollection 2021.

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 4th, 3rd, 2nd and 1st proximal holes were 0.64, 0.60, 0.56 and 0.52, respectively. The most dangerous screw hole was the 2nd proximal, in which all 18 screws had contacted or penetrated the nerve, followed by the risky 1st (12/18), 3rd (8/18) and 4th (2/18) holes.

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

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bone Plates / adverse effects*
  • Brachial Artery / injuries*
  • Cadaver
  • Female
  • Fracture Fixation, Internal / adverse effects*
  • Humans
  • Humeral Fractures / surgery*
  • Humerus*
  • Male
  • Middle Aged
  • Patient Positioning*
  • Radial Nerve / injuries*
  • Risk Factors

Grants and funding

Initials of the authors who received each award (C.C.) Grant numbers awarded to each author (REC 62-434-11-1) The full name of each funder (Faculty of Medicine, Prince of Songkla University) Did the sponsors or funders play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript? No, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.