Published online Feb 18, 2018. doi: 10.5312/wjo.v9.i2.7
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
Surgery is a widely applied as a treatment for the de Quervains Disease (QD). However, in 0.5 to 30% of cases, damage to the neurological structures have been reported this study was performed to try and provide a better understanding of the anatomy of the forearm to be able to decrease iatrogenic damage to the nerves of the forearm.
In this study the goal was to fins the optimal incision technique for the first dorsal compartment release for the Quervains disease. Up till now 4 main incision techniques have been described and no golden standard has been established. By using a new visualization technique the goal was to identify the best technique in order to prevent iatrogenic nerve damage during the first extensor compartment release procedure.
The goal of this study is to determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves. The nerves at risk are the superficial branch of the Radial Nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).
20 anubifix embalmed arms were dissected in a standardized way. Then the outline of the arm was marked and the arm was photographed in order to process it in the CASAM system. By using this system all arms could be rescaled to the dimensions of the average of the 20 embalmed arms. This ensures that the 20 nerve courses could be compared directly. Besides using CASAM the distance between the two branches of the SBRN running over de First Extensor Compartment (FEC) was measured.
The image created in CASAM showed 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.
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. The pre-study hypothesis was that there was a safe zone in which an incision for the Quervains disease could be made without chance of iatrogenic damage to the superficial branch of the radial nerve. This however was found not to be the case.
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. A randomized control trail comparing the incision techniques and their outcome could provide more evidence for the best possible incision technique in the future.