title: Relationship between axillary nerve and percutaneously inserted proximal humeral locking plate: a cadaver study.
abstract: OBJECTIVE
  The aim of this study was to investigate the relationship between the axillary nerve and the percutaneously inserted proximal humeral locking plate and to evaluate the risk of axillary nerve injury during percutaneous plate insertion.
  
  
  METHODS
  The study included 50 shoulders of 25 fresh frozen cadavers. A 5 cm incision was made from the anterolateral border of the acromion to the arm and a 5-hole 3.5-mm proximal humeral plate was inserted. The axillary nerve was then dissected. Plate holes which crossed the axillary nerve were noted. The distance between the axillary nerve and the lateral edge of the acromion and the length of the arm were measured and their relations evaluated with a correlation test.
  
  
  RESULTS
  The average arm length was 319 mm. The average distance between the axillary nerve and the lateral edge of the acromion was 60 mm. There was a significant correlation between the arm length and acromion-axillary nerve distance (p<0.05). The plate was inserted under the deltoid fascia in all shoulders except one. There were no axillary nerve lesions. In 1 case, the distal end of the plate was inserted in the deltoid muscle. No constant relationship between the plate holes and the axillary nerve was detected.
  
  
  CONCLUSIONS
  There is a risk of axillary nerve injury during percutaneous plate insertion. It must be ensured that the plate is inserted under the deltoid fascia during the surgery. The axillary nerve must be visible during application of the screws due to the impossibility of knowing which holes cross the axillary nerve.
authors.affiliation: Okmeydanı Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey. esenyel@yahoo.com.
authors.forename: Cem Zeki
authors.initials: CZ
authors.lastname: Esenyel
authors.affiliation: Bezmialem University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Semih
authors.initials: S
authors.lastname: Dedeoğlu
authors.affiliation: Üsküdar State Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Imren
authors.affiliation: Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Kahraman
authors.affiliation: Okmeydanı Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Çakar
authors.affiliation: MS Baltalimanı Bone Diseases Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Kahraman
authors.initials: K
authors.lastname: Öztürk
mesh_terms: D001365:Axilla / Q000294:innervation*; D001860:Bone Plates; D001917:Brachial Plexus / Q000293:injuries; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D012784:Shoulder Fractures / Q000601:surgery