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Percutaneous Pinning Through the Anatomic Snuff Box: Is There a Safe Zone?
Deana Mercer, MD; David Erik Peterson, MD; Christina Salas, PhD; Dustin Larson, MD; Zoe C Zimmer, BS; Moheb S Moneim, MD
University of New Mexico, Albuquerque, NM
Introduction: Percutaneous pin fixation is frequently used for fractures of the distal radius, carpal bones, or carpal ligament injuries. In 1995, an anatomical study was undertaken to establish a safe zone for placement of K-wires through the snuff box.[1] A 0.68 sq cm safe zone was defined as the area bordered by a 7.5 mm distance from the radial styloid (RS) to the radial artery (RA), 9.8 mm from the extensor pollicis brevis (EPB) to the 2ndsuperficial branch of the radial nerve (SR2) at the RA, and 8.1 mm from the EPB to SR2 at the RS. In the present study, we sought to verify whether these defined parameters would avoid injury to the EPB, SR2, SR3, RA, lateral antebrachial cutaneous nerve (LABCN), and the cephalic vein (CV).
Materials & Methods: Fifteen cadaver wrists were used in this study. Scapholunate repair was simulated by placement of wires through the scapholunate (SL) and scaphocapitate (SC) joints. A fellowship trained hand surgeon performed the percutaneous pinning procedure aiming for the safe zone as defined by [1]. Wrists were then dissected by a 2ndhand surgeon and calipers were used to measure the minimum distance from each pin to each structure.
Results:No structures were pierced by either pin. The pins were immediately adjacent to 17/30 LABCN, 17/30 CV, 2/30 RA, 4/30 SR2, 4/30 SR3, and 5/30 EPB. Average distances from the SL pin to each structure (in mm): 1.5 LABCN, 1.5 CV, 4.5 EPB, 6 SR2, 7 RA, and 9.5 SR3. Average distance from the SC pin to each structure (in mm): 2.5 LABCN, 2.5 CV, 3 EPB, 6.5 RA, 7 SR2, and 8.5 SR3.
Conclusion:In general, RA is the safest structure. Superficial structures (LABCN and CV) are at high risk for injury with percutaneous pin placement using the safe zone defined by [1]. Due to the high variability of the pin placement in combination with the variable location of anatomic structures in the snuff box, we conclude that there is not a safe zone for percutaneous pin placement through the snuff box.
References: [1] Steinberg BD, Plancher KD, Idler RS. Percutaneous Kirschner wire fixation through the snuff box: an anatomic study. J Hand Surg. 1995;20A:57-62.
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