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Risk of Injury to the Dorsal Branch of the Ulnar Nerve with Percutaneous Pinning of Ulnar-Sided Structures
Amish Naik, MD, PhD; Richard M. Hinds, MD; Nader Paksima, DO; John T. Capo, MD
NYU Hospital for Joint Diseases, New York, NY

Introduction: Percutaneous pinning is a commonly used technique for stabilization of fifth metacarpal fractures, lunotriquetral joint instability, ulnar styloid fractures, or distal radioulnar joint (DRUJ) instability. However, ulnar-sided pinning of these structures may place the dorsal branch of the ulnar nerve (DBUN) at risk. The purpose of this study was to assess the risk of injury to the DBUN with percutaneous pinning of commonly stabilized ulnar-sided structures.
Methods: Eleven fresh-frozen cadaveric upper extremities were assessed. Percutaneous pinning of the neck and base of fifth metacarpal, lunotriquetrial joint, ulnar styloid, and DRUJ with 0.045 inch Kirschner wires was performed under fluoroscopic guidance. Each specimen was then carefully dissected and the distance from the each pin to the DBUN was measured using a digital caliper. Direct injury to the DBUN was recorded. Pins that were found immediately adjacent to the DBUN were recorded. Comparisons between fixation locations were performed using Kruskal-Wallis/Mann-Whitney U tests and Fisher's Exact Test to analyze continuous and categorical data, respectively. The level of significance for all tests was P < 0.05.
Results: A significant difference in distance from pin to the DBUN was found among the pin locations (P < 0.001). Pairwise comparison revealed that the ulnar styloid pin was significantly closer to the DBUN than the fifth metacarpal neck (P < 0.001) and DRUJ pins (P < 0.001). The lunotriquetral pin was significantly closer to the DBUN than the fifth metacarpal neck (P < 0.001) and DRUJ pins (P = 0.004). Both the fifth metacarpal base (P = 0.005) and DRUJ (P = 0.025) pins were significantly closer to the DBUN than the fifth metacarpal neck pin. Two (18%) ulnar styloid pins and one (9%) lunotriquetral pin directly penetrated the DBUN, though no significantly greater risk of DBUN injury was found at any individual pinning location (P = 0.493). Of note, four (36%) ulnar styloid pins were directly adjacent to the DBUN. Data summarized in Table 1.
Conclusions: The current study demonstrates the close proximity (< 2 mm) of ulnar styloid and lunotriquetral pins to the DBUN. Although the occurrence of direct DBUN penetration was not significantly higher from ulnar styloid and lunotriquetral pinning in our series, we recommend performing mini-dissection with identification and protection of the nerve to mitigate the risk of iatrogenic injury due to its proximity to these sites.

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