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  1. Fulltext Risk of Axillary Nerve Injury in Standard Anterolateral Approach of Shoulder: Cadaveric Study
    Kongcharoensombat W, Wattananon P
    Malays Orthop J, 2018 Nov;12(3):1-5.
    PMID: 30555639 DOI: 10.5704/MOJ.1811.001
    Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length.
  2. Fulltext Injury of the Infrapatellar Branch of Saphenous Nerve Between Vertical and Oblique Skin Incision in Medial Opening Wedge High Tibial Osteotomy
    Kongcharoensombat W, Charoensri P
    Malays Orthop J, 2023 Jul;17(2):57-61.
    PMID: 37583531 DOI: 10.5704/MOJ.2307.009
    INTRODUCTION: The infrapatellar branch of saphenous nerve (IPBSN) has anatomic variations and prone to injury during surgery around the medial side of the knee. High tibial osteotomy is one of the procedures that may be risky to the IPBSN. This research was aimed to establish which skin incision (vertical vs oblique) is less likely to damage to the IPBSN and also to study the anatomy of the IPBSN, with the institutional review board reference (No. LH611054, date 10/1/2020). The primary outcomes are aimed to establish which skin incision (vertical vs oblique) is less damaging to the IPBSN. The secondary outcome is to study about the anatomy of the IPBSN.

    MATERIALS AND METHODS: Twenty-two fresh cadavers (forty-four knees) were dissected by randomisation under the block of four technique, and two different incisions were performed for each knee. Exploration was performed from the skin incision to the IPBSN around the incision zone. If the discontinuity of the nerve was found, it was classified as IPBSN injury. The anatomic measurement was performed. The IPBSN injury between two groups were analysed with the chi-square test.

    RESULTS: The risk of IPBSN injury in the oblique group was 2 from 22 knees (9.1%), and 12 knees from 22 knees (54.5%) in the vertical group (P=0.001). Most common number of branch(es) found, is one branch, the horizontal distance ranged from 2.6cm to 8.5cm (average 5.7±1.6), the vertical distance ranged from 4.4cm to 12.6cm (average 7.6±1.9) and the declination angle ranged from 6° to 87° (average 34.7±24.3).

    CONCLUSION: The risk of the IPBSN injury in oblique skin incision may be less than the vertical incision in the medial opening wedge HTO.

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