Intramuscular Martin‐Gruber anastomosis

Abstract

The incidence and morphology of the intramuscular Martin-Gruber anastomosis are presented based on the study of 118 human cadavers (55 male, 63 female). The Martin-Gruber anastomosis was found in 25 (21.2%) of the 118 cadavers. It occurred in 11 (20%) of the 55 male cadavers (4 bilateral, 7 unilateral; 5 left and 2 right) and in 14 (22.2%) of the 63 female cadavers (2 bilateral, 12 unilateral; 8 left and 4 right). Therefore, the Martin-Gruber anastomosis was found in 31 (13.1%) of the 236 upper limbs. According to a recent classification (Rodríguez-Niedenführ et al., 2000), pattern I was found in 29 cases (93.5%), corresponding to Type A in 13 (41.9%), Type B in 3 (9.7%) and Type C in 13 (41.9%), whereas pattern II was found in 2 cases (6.5%), both being a duplication of Type IC. Intramuscular Martin-Gruber anastomosis was a single anastomosis that originated in all cases from the anterior interosseous nerve (pattern IC) and then passed through a muscle bundle of the flexor digitorum profundus and behind the ulnar artery to join the ulnar nerve as a single connecting branch. It did not send branches to the flexor digitorum profundus. This intramuscular course was observed in 3 of the 13 cases of Type C anastomosis (23.1%) or 3 cases out of 31 Martin-Gruber anastomoses (10%).

Median and ulnar nerve anastomoses in the upper limb: A meta‐analysis

“…The anastomosis ran posterior to the ulnar artery in 89.8% of cases, agreeing with the study by Taams . However, the MGA has also been noted to be related to the anterior ulnar recurrent artery rather than the ulnar artery itself . The presence of an MGA should be taken into account during procedures such as open reduction and internal fixation of a radius/ulnar shaft fracture to reduce risk of injury.…”

“…A total of 6 studies ( n = 67 upper limbs) reported data on the position of the MGA with respect to the ulnar artery . In a majority of cases, the connection between the nerves was located posterior to the ulnar artery (89.8%, 95% CI, 74.9%–99.0%) rather than anterior (10.2%, 95% CI, 0.1%–25.1%; Cochran Q, P = 0.03; I‐squared = 58.7%, 95% CI, 0.0%–83.3%).…”

Nerves of the Upper Extremity

“…The communication is usually in the form of a branch that leaves the median in common either with muscular branches at the elbow or with the anterior interosseous nerve, and joins the ulnar nerve at about the middle of the forearm. Less frequently, the connection is between branches from the median and ulnar nerves to the flexor digitorum profundus, forming a loop (ansa) or small plexus, some of which may be intramuscular (Verchere 1883;Nakashima 1993;Rodriguez-Niedenfuhr et al 2002a).…”

Martin–gruber Anastomosis and Its Clinical Importance

“…Иногда сам анастомоз может быть дополнитель-ным потенциальным местом поражения за счет ком-прессии со стороны прилежащих мышц [28].…”