Incidence of an Anomalous Course of the Palmar Cutaneous Branch of the Median Nerve During Volar Plate Fixation of Distal Radius Fractures.
OBJECTIVE
Volar plating of distal radius fractures using an approach through the flexor carpi radialis (FCR) sheath is commonplace. The palmar cutaneous branch of the median nerve (PCB) is considered to run in a position adjacent to, but outside, the ulnar FCR sheath. Anatomic studies have not identified anatomic abnormalities relevant to volar plating. The purpose of this study was to determine the frequency of anomalous PCB branches entering the FCR sheath during volar plating.


METHODS
This observational study involved 10 attending hand surgeons during a 7-month period (July 2015-January 2016). Surgeons assessed, documented, and reported any PCB anomalies that were encountered during volar plating through a trans-FCR approach.


RESULTS
There were 182 volar plates applied that made up the study group. There were 10 cases (5.5%) of anomalous PCBs entering the FCR sheath. In 4 cases, the PCB pierced the radial FCR sheath proximally, crossed beneath the tendon, and traveled distally on the ulnar side. In 4 other cases, the PCB entered the FCR sheath proximally on the ulnar or central aspect of the sheath and remained within the sheath, staying along the ulnar or dorsal side of the tendon. In 1 case, the PCB pierced the ulnar distal aspect of the sheath and split into 2 branches. In 1 case, the PCB ran within the sheath along the radial aspect of the FCR.


CONCLUSIONS
Anomalies in the course of the PCB are more common than often considered. These variants are at risk during volar surgical approaches to the wrist that proceed through the FCR sheath.


CONCLUSIONS
Although dissecting along the radial side of the FCR sheath may protect the PCB in most cases, care must be taken to identify anomalous branches (if present) and protect them during surgery.
Division of Hand & Upper Extremity Surgery, The Rothman Institute, Philadelphia, PA.
Christopher
C
Jones
Division of Hand & Upper Extremity Surgery, The Rothman Institute, Philadelphia, PA.
Pedro
P
Beredjiklian
Division of Hand & Upper Extremity Surgery, The Rothman Institute, Philadelphia, PA.
Jonas L
JL
Matzon
Division of Hand & Upper Extremity Surgery, The Rothman Institute, Philadelphia, PA.
Nayoung
N
Kim
Division of Hand & Upper Extremity Surgery, The Rothman Institute, Philadelphia, PA. Electronic address: Kevin.lutsky@rothmaninstitute.com.
Kevin
K
Lutsky
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008475:Median Nerve / Q000002:abnormalities* / Q000601:surgery; D008875:Middle Aged; D053401:Palmar Plate / Q000294:innervation / Q000601:surgery*; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*
Distal radius fracture; palmar cutaneous branch; volar plate