CT Analysis of a Potential Safe Zone for Placing External Fixator Pins in the Humerus

Abstract

Background

Iatrogenic radial nerve injures are a common complication during the placement of external fixator pins at the lateral aspect of the humeral shaft. This study uses a three-dimensional measurement technique to locate a safe entry point for humeral pins when externally fixating the elbow. Methods: We fixed a guide wire to the radial nerve by a suture string, and used computed tomography (CT) to scan the upper limbs of cadaver specimens. Then, we measured the deviation angles of the radial nerve on the CT scans, and the distance from the radial nerve to the “elbow rotation center” (ERC). Result: The average distance from the radial nerve to the ERC was 87.3 ± 8.5 mm (range: 68–100 mm), 58.3 ± 11.3 mm (range: 32.12–82.84 mm), 106.3 ± 5.8 mm (range: 86.93–115.08 mm), and 113.9 ± 4.8 mm (range: 97.93–120.22 mm) at radial nerve deviation angles of 0°, –30°, 30°, and 45°, respectively. The average radial nerve deviation angle was –37.7° ± 7.7° and 123.9° ± 19.9° at 50 and 150 mm, respectively. Relative to 0°, the distance between the radial nerve and the ERC at radial nerve deviation angles of –30°, 30°, and 45° showed a significant difference (t = 18.20, p < 0.05; Z = 6.07, p < 0.001; Z = 6.40, p < 0.001, respectively). Conclusions: Pins inserted into the proximal humerus should be about 150 mm from the ERC with a radial nerve deviation angle of 30° anteriorly, and 50 mm from the ERC with a deviation angle of 30°–45° posteriorly.

Keywords:

• elbow external fixator
• radial nerve
• iatrogenic injuries
• anatomical study
• CT scan
• three-dimensional measurement

Acknowledgments

The authors would like to thank Xiaochen Bi (Head of the Anatomy Department), our statistical consultant, Weijun Zheng, and all staff at our institution who helped with this study.

Declaration of interest

The authors report no conflict of interest.

Ethic statement

Our research was approved by the Ethics Committee of the Sixth People’s Hospital of Xiaoshan District.