Localization of radial nerve at the spiral groove.

We read with great interest the report by Demirkale et al. in your reputed journal [1]. We would like to congratulate them for conducting this study which has the potential for possible clinical implication. They compared the distance between radial nerve at the midpoint of the spiral groove (as located on ultrasound examination) and the tip of the olecranon process with the distance between the most distal wrist flexion crease and fingertips on 100 healthy volunteers. They found that the mean distance from radial nerve at the midpoint of the spiral groove and the tip of the olecranon process was 16.22 ​cm (12.5–20.5 ​± ​1.55), and it correlated best with mean distances from the most distal wrist crease to fifth fingertips which was 15.62 ​cm (12.5–20.5 ​± ​1.34), especially in female gender. They concluded this method can be used to guide the surgical explorations. However, we have following points to make:

While the authors emphasize the ‘preoperative’ localization of radial nerve with reference to a distal bony point (olecranon process), an orthopaedic surgeon would be more interested in knowing the ‘intraoperative’ localization. All the methods, based on the bony landmarks, to localize the radial nerve are likely to fail in the clinical trauma setting as these bony landmarks will be disturbed. In the trauma setting, which necessitates operative plate stabilization of humerus utilizing the midline posterior approach, the operating surgeon will strive for a reliable soft tissue point intraoperatively to help locate the radial nerve. Such a soft tissue landmark was described in a landmark article, where the authors utilizes the ‘apex of triceps aponeurosis’ for intraoperative guidance [2]. They concluded that the mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 ​cm and this distance remained the same for both intact arm cases (cadavers) and fractured arm cases (trauma patients). Addition of this in the discussion and references of their article would have improved the coverage of the topic in question.

Authorship statement

The manuscript has been read and approved by all the authors and requirement for authorship of this document has been met. Each author certifies that the work and all investigations were conducted in conformity with ethical principles of research. Each author believes that the manuscript represents honest work. They did not receive grants from any commercial entity in support of this work. Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Conflict of Interest

The authors have no conflicts of interest to disclose in relation to this article.