Background The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm. Questions/purposes We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve. Materials and MethodsWe performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function. Results The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients' height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group. Conclusion The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus. IntroductionOwing to an increase in high-energy trauma cases, the incidence of fractures of the humerus diaphysis is increasing. Operative treatment of humeral fractures, especially the distal third region, chronic osteomyelitis of the distal third of the humerus requiring sequestrectomy and radial nerve palsy requiring exploration, usually requires a posterior approach to the humerus. This approach causes iatrogenic radial nerve injury in 0% to Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Background:Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. This study aims to biomechanically compare the cutout resistance as well as modes of failure of DCS and PFN in reverse oblique trochanteric fractures.Materials and Methods:Sixteen freshly harvested cadaveric proximal femoral specimens were randomly assigned to three mean bone mineral density matched groups, eight of which were implanted with 95° DCS and the other eight with PFN. The constructs were made unstable to resemble a reverse oblique trochanteric fracture by removing a standard size posteromedial wedge. These constructs were subjected to computer controlled cyclic compressive loading with 200 kg at a frequency of 1 cycle/second (1 Hz) and end points of both the groups were analyzed.Results:The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001). The PFN group resisted more number of cycles than the DCS group (P=0.03) and showed lesser number of component failures as compared with the DCS group (P=0.003).Conclusions:The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.

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