title: Safety of dorsal wrist arthroscopy portals: A magnetic resonance study.
abstract: In wrist arthroscopy, the standard dorsal portals are the most commonly used. However, their placement can be associated with injuries to the neurovascular structures of the radiocarpal joint. The present study assessed and compared the distance of commonly used dorsal portals to radial and ulnar neurovascular structures. Forty patients (20 males, 20 females) were evaluated with T1-weighted spin-echo (SE) magnetic resonance (MR) sequences. We measured the distance between 1-2 and 3-4 portals and radial vascular bundle and the nearest branch of the superficial branch of radial nerve (SBRN). We also measured the distance between 4 and 5, 6/U and 6/R and ulnar vascular bundle and the nearest branch of the dorsal ulnar nerve (DUN). The median age of patients was 39 years (95% IC 36.97-43.32 years). The 3-4 portal was farther away from the vascular structure than the 1-2 portal (P < 0.0001), 4-5 portal (P = 0.008), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). Moreover, the 3-4 portal was farther away from the nerve branch than the 1-2 portal (P < 0.0001), 4-5 portal (P < 0.0001), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). No statistical significant differences were found between the two genders. The 3-4 and 4-5 portals are the farthest away from the neurovascular structures, and likely reduce the risk to damage these structures. On the other hand, the 1-2 and 6/U portals likely increase the risk of neurovascular damage, because of their proximity to neurovascular structures.
  
  
  METHODS
  Diagnostic study; Level III.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Loppini
authors.affiliation: Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Del Vescovo
authors.affiliation: Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cazzato
authors.affiliation: Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Bruno Beomonte
authors.initials: BB
authors.lastname: Zobel
authors.affiliation: Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy; Centre for Sport and Exercise Medicine, Queen Mary University of London, London, England, United Kingdom. Electronic address: n.maffulli@qmul.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000294:innervation / Q000601:surgery*
keywords: Dorsal portals; Dorsal ulnar nerve; Radial vascular bundle; Superficial radial nerve; Ulnar vascular bundle; Wrist arthroscopy