{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T11:48:51Z","timestamp":1748346531136,"version":"3.37.3"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Preventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>The median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90\u00b0 flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Basic Science Study.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-021-03753-y","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T06:03:07Z","timestamp":1611381787000},"page":"813-821","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint"],"prefix":"10.1007","volume":"142","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6284-7977","authenticated-orcid":false,"given":"Davide","family":"Cucchi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Luceri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-8099","authenticated-orcid":false,"given":"Alessandra","family":"Menon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars Peter","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koroush","family":"Kabir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro Simone","family":"Randelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Arrigoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kilian","family":"Wegmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,23]]},"reference":[{"key":"3753_CR1","doi-asserted-by":"publisher","first-page":"e451","DOI":"10.1097\/BOT.0000000000001266","volume":"32","author":"J Morellato","year":"2018","unstructured":"Morellato J, Louati H, Desloges W et al (2018) Fixation of anteromedial coronoid facet fractures. 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Author FL declares that he has no conflict of interest. Author AM declares that she has no conflict of interest. Author LPM declares consultancy for Arthrex, Medartis and Tornier, outside the submitted work; payment for travel\/accommodations expenses from Arthrex, Medartis and Tornier, outside the submitted work; institutional grants from Medartis and Tornier, outside the submitted work. Author KK declares that he has no conflict of interest. Author PSR declares consultancy for Arthrex, Depuy, Microport and Medacta, outside the submitted work. Author PA declares payment for development of educational presentations from Arthrex, outside the submitted work. Author KW declares consultancy for Arthrex, Medartis and Tornier, outside the submitted work; payment for travel\/accommodations expenses from Arthrex, Medartis and Tornier, outside the submitted work; institutional grants from Medartis and Tornier, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Nicola\u2019s Foundation & ICLO Research Center (ID19931). This article does not contain any studies with human participants performed by any of the authors (cadaveric study).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not required (cadaver study).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}