title: Proximity of the posterior interosseous nerve during cortical button guidewire placement for distal biceps tendon reattachment.
abstract: OBJECTIVE
  To assess the distance between the posterior interosseous nerve (PIN) and a distally and ulnarly directed guide pin for placement of a cortical button to reattach a distal biceps tendon.
  
  
  METHODS
  We used 10 fresh frozen cadaveric upper limbs without deformities and identified the PIN through a dorsal approach. We performed a single incision anterior surgical approach, detached the biceps tendon, and drilled a 1.6-mm K-wire from the base of the biceps tendon insertion in 3 different trajectories, sequentially, measuring the following drilling angles: 30° distal and 30° ulnar, 30° ulnar, and 30° distal. In each testing scenario, we measured the minimum distance in millimeters between the tip of the K-wire and the PIN using a digital caliper through the dorsal incision.
  
  
  RESULTS
  The mean and median distances from the guide wire to the PIN in each testing trajectory were each significantly different from each other, with the 30° ulnar direction leading to the greatest distance from the nerve.
  
  
  CONCLUSIONS
  We found that the 30° ulnar drilling direction resulted in a significantly greater distance from the guide wire to the PIN, in comparison with the distal-ulnar and the distal-only trajectories.
  
  
  CONCLUSIONS
  This study helps define the safe trajectory for guide wire placement in bicortical fixation of distal biceps tendon injuries.
authors.affiliation: University of Utah Department of Orthopedic Surgery, Salt Lake City, UT.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thumm
authors.affiliation: University of Utah Department of Orthopedic Surgery, Salt Lake City, UT.
authors.forename: Douglas
authors.initials: D
authors.lastname: Hutchinson
authors.affiliation: University of Utah Department of Orthopedic Surgery, Salt Lake City, UT.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: University of Utah Department of Orthopedic Surgery, Salt Lake City, UT.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Drago
authors.affiliation: University of Utah Department of Orthopedic Surgery, Salt Lake City, UT. Electronic address: Andrew.Tyser@hsc.utah.edu.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Tyser
mesh_terms: D000368:Aged; D001858:Bone Nails; D001864:Bone Wires; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D013708:Tendon Injuries / Q000601:surgery*; D014459:Ulnar Nerve / Q000033:anatomy & histology / Q000601:surgery*; D034941:Upper Extremity / Q000033:anatomy & histology / Q000601:surgery
keywords: Distal biceps repair; endobutton; posterior interossesous nerve