American Society for Peripheral Nerve

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Posterior Interosseous Nerve Graft: Utilizing A Ratio Of Surface Anatomy To Predict Length For Digital Nerve Reconstruction
Brad Vivace, BS1; Swapnil D Kachare, MD1; Luke Meredith, BS1; Christina Kapsalis, BS1; Milind D Kachare, MD2; Bradon Wilhelmi, MD1
1University of Louisville, Louisville, KY, 2Robert Wood Johnson Medical School, New Brunswick, NJ

Objective: In digital nerve injuries where the size of the defect precludes coaptation, peripheral nerve grafts remain the superior treatment of choice. The sensory posterior interosseous nerve (PIN) is an ideal candidate as it is of similar caliber to the digital nerves and leaves no perceptible deficit upon harvest, however the length of PIN available may vary by patient size. In this study we sought to develop a method to accurately predict the length of PIN in regards to individual patient anthropometry.

Methods: A cadaveric dissection study was performed in a fresh tissue lab. The length of the sensory branch of the PIN and various anthropometric measurements were made in respect to surface anatomy to develop a predictable ratio.

Results: A total of 7 specimens, 4 males and 3 females, were obtained. On average the length of the PIN was 6.33 cm (range: 4.9-9.6 cm) and the length of the ulna was 25.8 cm (range: 23.8-30.6 cm). The ratio of PIN to ulnar length was 0.248 with a R = 0.783 and R2 = 0.613. Using one-fourth (0.25) the length of ulna, the mean predicted length of the PIN was 6.46 cm (range: 5.92-7.65 cm) (Table 1). On univariate analysis, there was no significant difference between the measured and predicted PIN length, p=0.73.

Conclusion: Anthropometric ratios predicated on reproducible surface anatomy are a viable and useful tool in predicting the available nerve length for potential digital nerve reconstruction in cadaveric specimens. Total available length of PIN available for harvest was accurately and reproducibly predicted by a ratio of one-fourth the length of the ulna.

Table 1: Demographics and Measurements

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