From the Research
The superficial branch of the radial nerve is at risk of damage during dorsal plating procedures for distal radius fractures, and it is located in the distal forearm, where it courses beneath the brachioradialis muscle before emerging between the brachioradialis and extensor carpi radialis longus tendons. This nerve is particularly vulnerable during surgical exposure for dorsal plating, especially when making the skin incision and during retraction of soft tissues 1. The superficial branch of the radial nerve provides sensory innervation to the dorsoradial aspect of the hand and thumb, and damage to this nerve can result in painful neuroma formation or sensory deficits in the dorsal radial hand.
To minimize the risk of injury to this nerve, surgeons should identify and protect it during the approach, typically by retracting it along with the extensor tendons 2. The longitudinal incision for dorsal plating should be made slightly ulnar to the Lister's tubercle to minimize the risk of injury to this nerve. Understanding the anatomical course of the superficial branch of the radial nerve is essential for preventing iatrogenic injury during distal radius fracture fixation. Some studies have shown that plating to the second metacarpal decreases the risk of entrapment of extensor tendons compared with plating to the third metacarpal 2, while others have reported complications related to tendon and nerve entrapment with dorsal plating 3, 4. However, the most recent and highest quality study suggests that the superficial branch of the radial nerve is at risk of damage during dorsal plating procedures for distal radius fractures 1.
Key points to consider when performing dorsal plating procedures for distal radius fractures include:
- Identifying and protecting the superficial branch of the radial nerve during the approach
- Making the longitudinal incision slightly ulnar to the Lister's tubercle to minimize the risk of injury to this nerve
- Retracting the nerve along with the extensor tendons to prevent damage
- Being aware of the potential complications related to tendon and nerve entrapment with dorsal plating.