A morphometric study of the palmar cutaneous branch of the median nerve: is there a risk of injury when volar plate fixation is used for the treatment of distal radial fractures?

Richards, O., O'Sullivan, E., Border, S. and Webb, A. (2011) A morphometric study of the palmar cutaneous branch of the median nerve: is there a risk of injury when volar plate fixation is used for the treatment of distal radial fractures? [in special issue: Abstracts Presented at the Summer Meeting of the British Association of Clinical Anatomists, Laboratory of Human Anatomy, University of Glasgow, Glasgow, United Kingdom from 21st to 22nd of July, 2010] Clinical Anatomy, 24 (3), 393. (doi:10.1002/ca.21162).

Abstract

Volar plating of distal radius fractures has recently gained favour due to complications associated with external fixation and dorsal plating techniques. The aim of this study was to determine the impact of the incision made in volar fixation on the palmar cutaneous branch of the median nerve (PCBMN). A standard Henry's approach was applied to 10 pairs of human cadaver hands. Further dissection was undertaken to provide morphometric data. The PCBMN was not damaged by the incision in any of the specimens and was absent in two specimens. Mean distances from the origin of the PCBMN to the distal wrist crease (DWC), scaphoid tubercle (ST) and bistyloid line (BSL) were 55.15, 76.04, and 52.38 mm, respectively. From the flexor carpi radialis tendon, ST and radial styloid process the mean distances to the PCBMN were 4.46, 22.82, and 29.07 mm, respectively. The nerve entered the flexor retinaculum at a mean of 10.88, 22.73, and 10.69 mm from the BSL, ST and DWC, respectively. Measurement reliability ranged from ICC 0.98 to 1.00 (intra-observer) and 0.96 to 1.00 (inter-observer). These findings suggest that damage to the PCBMN from this technique is unlikely but knowledge of variants can help minimize the risk of injury.

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