Figures A and B show a pre and post-operative radiograph of a both bone forearm fracture. The posterior interosseus nerve is at risk during surgical approaches to this fracture pattern and care should be taken.
Ropars et al retrospectively reviewed 15 patients who underwent treatment for radial nerve and PIN palsy. For PIN palsy, they concluded the most beneficial transfers included transferring the flexor carpi radialis to the finger extensors (to restore finger extension) and palmaris longus to the extensor pollicis longus (to restore extension of the thumb). In contrast with a radial nerve palsy, with a PIN palsy the patient has adequate wrist extension due to intact ECRL (providing radial wrist extension) supplied by the radial nerve proximal to the PIN.
Ustün et al in their cadaveric studies were able to show that it is possible to perform posterior interosseous nerve neurotization via the median nerve.
Hirachi et al reviewed the results of 17 traumatic PIN palsies that were treated either with nerve repair, tendon transfers, or nonoperatively. They noted that associated muscle damage resulted in poorer results.
The muscles involved in the suggested transfer (FCR, ED, PL, EPL) are shown in illustration A-D.
Ropars M, Dréano T, Siret P, Belot N, Langlais F. Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis. J Hand Surg Br. 2006 Oct;31(5):502-6. Epub 2006 Aug 22.
PMID:16928411 (Link to Abstract)
Ustün ME, Ogün TC, Büyükmumcu M. Neurotization as an alternative for restoring finger and wrist extension. J Neurosurg. 2001 May;94(5):795-8.
PMID:11354412 (Link to Abstract)
Hirachi K, Kato H, Minami A, Kasashima T, Kaneda K. Clinical features and management of traumatic posterior interosseous nerve palsy. J Hand Surg Br. 1998 Jun;23(3):413-7.
PMID:9665539 (Link to Abstract)