Cargando…

MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation

BACKGROUND: Percutaneous fixation of proximal humeral fractures places the axillary nerve and posterior humeral circumflex artery at risk for injury. Safe operative zones for the axillary nerve are described based on external measurements from anatomic landmarks, but no study to date has incorporate...

Descripción completa

Detalles Bibliográficos
Autores principales: Wilkinson, Eric B., Williams, Johnathan F., Paul, Kyle D., He, Jun Kit, Hutto, Justin R., Narducci, Carl A., McGwin, Gerald, Brabston, Eugene W., Ponce, Brent A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910741/
https://www.ncbi.nlm.nih.gov/pubmed/33681839
http://dx.doi.org/10.1016/j.jseint.2020.11.002
_version_ 1783656183017504768
author Wilkinson, Eric B.
Williams, Johnathan F.
Paul, Kyle D.
He, Jun Kit
Hutto, Justin R.
Narducci, Carl A.
McGwin, Gerald
Brabston, Eugene W.
Ponce, Brent A.
author_facet Wilkinson, Eric B.
Williams, Johnathan F.
Paul, Kyle D.
He, Jun Kit
Hutto, Justin R.
Narducci, Carl A.
McGwin, Gerald
Brabston, Eugene W.
Ponce, Brent A.
author_sort Wilkinson, Eric B.
collection PubMed
description BACKGROUND: Percutaneous fixation of proximal humeral fractures places the axillary nerve and posterior humeral circumflex artery at risk for injury. Safe operative zones for the axillary nerve are described based on external measurements from anatomic landmarks, but no study to date has incorporated advanced imaging to help guide surgical procedures in the region of the axillary neurovascular bundle (ANVB). We sought to define the location and trajectory of the ANVB in relation to osseous landmarks using magnetic resonance imaging (MRI) measurements. METHODS: Retrospective review of 750 consecutive MRI studies was performed with 55 imaging studies meeting inclusion criteria for patient positioning, image alignment, and quality. Five measurements were performed including the distance from mid-lateral acromion to lateral ANVB, mid-lateral acromion to medial ANVB, greater tuberosity to lateral ANVB, vertical distance between inferior anatomic neck and lateral ANVB, and angle the ANVB crosses the humerus. Height, gender, and age were recorded. Analysis was performed using ANOVA and Pearson correlation tests. RESULTS: The lateral ANVB was below the inferior articular margin of the humeral head by an average of 12.9 ± 3.9 mm and within a 22 mm window. It was an average of 57.4 ± 5.1 mm from the lateral mid-acromion, and 34.7 ± 4.3 mm below the greater tuberosity. The angle formed by the ANVB crossing the humerus averaged 19.5 ± 3.9 degrees upward from medial to lateral. Height and gender directly impacted measurements. CONCLUSIONS: The use of the inferior humeral head articular margin provides a radiographic landmark to aid intraoperative lateral ANVB assessment which may be helpful during percutaneous fracture fixation.
format Online
Article
Text
id pubmed-7910741
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-79107412021-03-04 MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation Wilkinson, Eric B. Williams, Johnathan F. Paul, Kyle D. He, Jun Kit Hutto, Justin R. Narducci, Carl A. McGwin, Gerald Brabston, Eugene W. Ponce, Brent A. JSES Int Shoulder BACKGROUND: Percutaneous fixation of proximal humeral fractures places the axillary nerve and posterior humeral circumflex artery at risk for injury. Safe operative zones for the axillary nerve are described based on external measurements from anatomic landmarks, but no study to date has incorporated advanced imaging to help guide surgical procedures in the region of the axillary neurovascular bundle (ANVB). We sought to define the location and trajectory of the ANVB in relation to osseous landmarks using magnetic resonance imaging (MRI) measurements. METHODS: Retrospective review of 750 consecutive MRI studies was performed with 55 imaging studies meeting inclusion criteria for patient positioning, image alignment, and quality. Five measurements were performed including the distance from mid-lateral acromion to lateral ANVB, mid-lateral acromion to medial ANVB, greater tuberosity to lateral ANVB, vertical distance between inferior anatomic neck and lateral ANVB, and angle the ANVB crosses the humerus. Height, gender, and age were recorded. Analysis was performed using ANOVA and Pearson correlation tests. RESULTS: The lateral ANVB was below the inferior articular margin of the humeral head by an average of 12.9 ± 3.9 mm and within a 22 mm window. It was an average of 57.4 ± 5.1 mm from the lateral mid-acromion, and 34.7 ± 4.3 mm below the greater tuberosity. The angle formed by the ANVB crossing the humerus averaged 19.5 ± 3.9 degrees upward from medial to lateral. Height and gender directly impacted measurements. CONCLUSIONS: The use of the inferior humeral head articular margin provides a radiographic landmark to aid intraoperative lateral ANVB assessment which may be helpful during percutaneous fracture fixation. Elsevier 2021-01-09 /pmc/articles/PMC7910741/ /pubmed/33681839 http://dx.doi.org/10.1016/j.jseint.2020.11.002 Text en © 2021 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Shoulder
Wilkinson, Eric B.
Williams, Johnathan F.
Paul, Kyle D.
He, Jun Kit
Hutto, Justin R.
Narducci, Carl A.
McGwin, Gerald
Brabston, Eugene W.
Ponce, Brent A.
MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title_full MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title_fullStr MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title_full_unstemmed MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title_short MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation
title_sort mri evaluation of axillary neurovascular bundle: implications for minimally invasive proximal humerus fracture fixation
topic Shoulder
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910741/
https://www.ncbi.nlm.nih.gov/pubmed/33681839
http://dx.doi.org/10.1016/j.jseint.2020.11.002
work_keys_str_mv AT wilkinsonericb mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT williamsjohnathanf mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT paulkyled mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT hejunkit mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT huttojustinr mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT narduccicarla mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT mcgwingerald mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT brabstoneugenew mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation
AT poncebrenta mrievaluationofaxillaryneurovascularbundleimplicationsforminimallyinvasiveproximalhumerusfracturefixation