Review Question - QID 3102

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.