Poublon AR, Kleinrensink GJ, Kerver AL, Coert JH, Walbeehm ET. Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study. World J Orthop 2018; 9(2): 7-13 [PMID: 29468135 DOI: 10.5312/wjo.v9.i2.7]
Corresponding Author of This Article
Alexander R Poublon, MD, Academic Research, Department of Neuroscience and Anatomy, Erasmus MC, Postbus 2040, Rotterdam, Zuid-Holland 3000 CA, Netherlands. a.poublon@erasmusmc.nl
Research Domain of This Article
Orthopedics
Article-Type of This Article
Basic Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2018; 9(2): 7-13 Published online Feb 18, 2018. doi: 10.5312/wjo.v9.i2.7
Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study
Alexander R Poublon, Gert-Jan Kleinrensink, Anton LA Kerver, J Henk Coert, Erik T Walbeehm
Alexander R Poublon, Gert-Jan Kleinrensink, Department of Neuroscience and Anatomy, Erasmus MC, Rotterdam, Zuid-Holland 3000 CA, Netherlands
Anton LA Kerver, Department of Plastic and Reconstructive surgery, Catharina Ziekenhuis, Eindhoven, Noord-Brabant 5623 EJ, Netherlands
J Henk Coert, Department of Plastic Surgery, UMC Utrecht, Utrecht, Utrecht 3584 CX, Netherlands
Erik T Walbeehm, Department of Plastic Surgery, Radboud UMC, Gelderland, Nijmegen 6500 HB, Netherlands
Author contributions: Poublon AR and Kerver ALA performed the research, did the experiments and wrote the paper; Kleinrensink GJ, Coert JH and Walbeehm ET helped with study design and writing of the paper.
Institutional review board statement: As this is a cadaveric study, no institutional review board statement is required.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional date was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alexander R Poublon, MD, Academic Research, Department of Neuroscience and Anatomy, Erasmus MC, Postbus 2040, Rotterdam, Zuid-Holland 3000 CA, Netherlands. a.poublon@erasmusmc.nl
Telephone: +31-62-8426599 Fax: +31-10-7043257
Received: September 7, 2017 Peer-review started: September 24, 2017 First decision: November 6, 2017 Revised: January 6, 2018 Accepted: January 23, 2018 Article in press: January 23, 2018 Published online: February 18, 2018
Abstract
AIM
To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).
METHODS
Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.
RESULTS
This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.
CONCLUSION
CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.
Core tip: Although many incision techniques can be found in literature no consensus on the best incision technique has been established. The study shows a large variation in the course of the superficial branch of the radial nerve over the first extensor compartment. However no complete safe zone can be defined. The choice of incision remains surgeons’ preference and surgical skills are paramount to prevent iatrogenic nerve damage.
