EXTERNAL FIXATION Mr Lee Van Rensburg 37 YO

EXTERNAL FIXATION Mr Lee Van Rensburg

37 YO Male

3478195 CT angio

LORIF 942088

Pin Diameter Guidelines < 1/3 rd of Diameter Humerus – 5 mm Forearm – 4 mm Hand – 3 mm

Elbow external fixators Static Dynamic

45 YO RTA

Radial nerve Roots C 5 -T 1 Posterior cord Exits axilla via lower triangular space Teres Major – superior Long head triceps – medial Humerus – lateral Round spiral groove pierces lateral intermuscular septum, running anterior to intermuscular septum, between brachialis and brachioradialis Passes anterior to lateral epicondyle giving off superficial branch of radial nerve then piercing two heads of supinator

Clin Orthop Relat Res (2008) 466: 135– 138

2. 5 cm proximal to apex +- 0. 4 cm 10 Cadaver 30 Patients Clin Orthop Relat Res (2011) 469: 2638– 2644

BEWARE THIS PAPER IS DANGEROUS Anatomic relationship of the radial nerve to the elbow joint: clinical implications of safe pin placement. Kamineni S, Ankem H, Patten DK. 70 cadavers Lateral radial nerve height (LRNH) Average 102 mm +/- 10 mm (range 75 -129 mm) Transepicondylar (TED) distance 62 mm +/- 6 mm (range 52 -78 mm) Ratio of LRNH to TED Average of 1. 7 +/- 0. 2 (range 1. 4 -2. 0) Absolute safe zone for pin entry into the lateral distal humerus is: area lying in distal 70% TED from lateral epicondyle Clin Anat. 2009 Sep; 22(6): 684 -8

Used Kamineni guide, distal pin placed in safe zone Distal to 70% of TED Open 7 cm incision dissection to bone Developed high radial nerve 3 days after ex fix Explored Nerve tented posterior to distal half pin, proximal free Be Afraid J Shoulder Elbow Surg (2013) 22, e 12 -e 16