Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2018; 9(2): 7-13
Published online Feb 18, 2018. doi: 10.5312/wjo.v9.i2.7
Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study
Alexander R Poublon, Gert-Jan Kleinrensink, Anton LA Kerver, J Henk Coert, Erik T Walbeehm
Alexander R Poublon, Gert-Jan Kleinrensink, Department of Neuroscience and Anatomy, Erasmus MC, Rotterdam, Zuid-Holland 3000 CA, Netherlands
Anton LA Kerver, Department of Plastic and Reconstructive surgery, Catharina Ziekenhuis, Eindhoven, Noord-Brabant 5623 EJ, Netherlands
J Henk Coert, Department of Plastic Surgery, UMC Utrecht, Utrecht, Utrecht 3584 CX, Netherlands
Erik T Walbeehm, Department of Plastic Surgery, Radboud UMC, Gelderland, Nijmegen 6500 HB, Netherlands
Author contributions: Poublon AR and Kerver ALA performed the research, did the experiments and wrote the paper; Kleinrensink GJ, Coert JH and Walbeehm ET helped with study design and writing of the paper.
Institutional review board statement: As this is a cadaveric study, no institutional review board statement is required.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional date was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alexander R Poublon, MD, Academic Research, Department of Neuroscience and Anatomy, Erasmus MC, Postbus 2040, Rotterdam, Zuid-Holland 3000 CA, Netherlands. a.poublon@erasmusmc.nl
Telephone: +31-62-8426599 Fax: +31-10-7043257
Received: September 7, 2017
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
Processing time: 39 Days and 20 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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).

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.