Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleThe Effect of Drill Trajectory on Proximity to the Posterior Interosseous Nerve During Cortical Button Distal Biceps Repair
Section snippets
Methods
Ten fresh-frozen unmatched adult cadaveric arms were brought to room temperature. The arms had been harvested at the midhumerus and were intact distally. No visible deformities or evidence of previous surgery was noted in any of the specimens. The gender and side of each specimen were recorded, as well as the length, from the tip of the ulnar styloid to the olecranon process.
The PIN was exposed in each specimen through a longitudinal incision in the proximal dorsal forearm. The PIN was
Results
Of the specimens, 5 were right arms and 5 were left arms. The mean ulnar length was 27.4 cm, with a range of 24.0 to 31.5 cm. Three specimens were female. The mean specimen age was 71.8 years, with a range of 43 to 96 years.
When drilling across the radius using trajectory A, we found that the guide pin exited the dorsal cortex of the radius at a mean of 11.2 ± 3.2 mm (95% confidence interval [CI], 8.9 to 13.5 mm) from the PIN. Drill trajectory B resulted in a mean distance of 2.0 ± 2.2 mm (95%
Discussion
Repair of distal biceps ruptures has been shown to improve subjective and objective outcome measures compared with nonoperative treatment.3, 7, 12 Using a cortical button to repair the biceps to the proximal radius has recently gained popularity. This novel technique, described by Bain et al.,13 has been shown to have several advantages over previously described repair techniques. First, the cortical button repair has consistently shown stronger initial fixation strength compared with
Conclusions
On the basis of the results of this anatomic study, when using the cortical button distal biceps repair technique, we recommend drilling across the radius at 90° to its longitudinal axis and aiming from 0° to 30° ulnarly, with the patient's forearm in full supination. This provides an increased margin of safety to prevent injury to the PIN compared with drilling radially or distally.
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Statistical support for this publication was made possible by grant UL1 RR024146 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or NIH. Information on re-engineering the clinical research enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.
The author reports no conflict of interest.