{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:21:39Z","timestamp":1791339699322,"version":"4.3.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,12,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The surgical anatomy of upper-extremity peripheral nerves in adults has been well described as \u201csafe zones\u201d or specific distances from osseous landmarks. In pediatrics, relationships between nerves and osseous landmarks remain ambiguous. The goal of our study was to develop a model to accurately predict the location of the radial and axillary nerves in children to avoid iatrogenic injury when approaching the humerus in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective review of 116 magnetic resonance imaging (MRI) scans of entire humeri of skeletally immature patients; 53 of these studies met our inclusion criteria. Two independent observers reviewed all scans. Arm length was measured as the distance between the lateral aspect of the acromion and the lateral epicondyle. We then calculated the distances (defined as the percentage of arm length) between the radial nerve and distal osseous landmarks (the medial epicondyle, transepicondylar line, and lateral epicondyle) as well between the axillary nerve and the most lateral aspect of the acromion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The axillary nerve was identified at a distance equaling 18.6% (95% confidence interval [CI], \u00b10.62%) of arm length inferior to the lateral edge of the acromion. The radial nerve crossed (1) the medial cortex of the posterior part of the humerus at a distance equaling 63.19% (95% CI: \u00b10.942%) of arm length proximal to the medial epicondyle, (2) the middle of the posterior part of the humerus at a distance equaling 53.9% (95% CI: \u00b11.08%) of arm length proximal to the transepicondylar line, (3) the lateral cortex of the posterior part of the humerus at a distance equaling 45% (95% CI: \u00b10.99%) of arm length proximal to the lateral epicondyle, and (4) from the posterior to the anterior compartment at a distance equaling 35.3% (95% CI: \u00b10.92%) of arm length proximal to the lateral epicondyle. A strong linear relationship between these distances and arm length was observed, with an intraclass correlation coefficient of &gt;0.9 across all measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The positions of the radial and axillary nerves maintain linear relationships with arm lengths in growing children. The locations of these nerves in relation to palpable osseous landmarks are predictable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Knowing the locations of upper-extremity peripheral nerves as a proportion of arm length in skeletally immature patients may help to avoid iatrogenic injuries during surgical approaches to the humerus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00019","type":"journal-article","created":{"date-parts":[[2019,10,14]],"date-time":"2019-10-14T11:47:22Z","timestamp":1571053642000},"page":"2101-2110","source":"Crossref","is-referenced-by-count":10,"title":["Establishing Safe Zones to Avoid Nerve Injury in the Approach to the Humerus in Pediatric Patients"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7344-9293","authenticated-orcid":false,"given":"Ryan","family":"O\u2019Shea","sequence":"first","affiliation":[{"name":"Kaiser Permanente, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8922-4136","authenticated-orcid":false,"given":"Jyoti","family":"Panwar","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Radiology, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6803-0669","authenticated-orcid":false,"given":"William","family":"Chu Kwan","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-532X","authenticated-orcid":false,"given":"Jennifer","family":"Stimec","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5840-4601","authenticated-orcid":false,"given":"Mark W.","family":"Camp","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4228-7292","authenticated-orcid":false,"given":"Martin","family":"Gargan","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol, Bristol, England"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,10,11]]},"reference":[{"issue":"12","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"3779","DOI":"10.1007\/s11999-014-3509-x","article-title":"Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis","volume":"472","author":"Bloom","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/00005131-199602000-00002","article-title":"Lateral approach to the humeral shaft: an alternative approach for fracture treatment","volume":"10","author":"Mills","year":"1996","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"998","DOI":"10.3171\/jns.2001.95.6.0998","article-title":"Surgical landmarks for the proximal portion of the axillary nerve","volume":"95","author":"Tubbs","year":"2001","journal-title":"J Neurosurg."},{"issue":"6","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1002\/(SICI)1098-2353(1998)11:6<372::AID-CA2>3.0.CO;2-R","article-title":"Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences","volume":"11","author":"Contreras","year":"1998","journal-title":"Clin Anat."},{"key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/00003086-200102000-00004","article-title":"Upper extremity peripheral nerve anatomy: current concepts and applications","volume":"383","author":"Mazurek","year":"2001","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/ca.10181","article-title":"One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm","volume":"17","author":"Fleming","year":"2004","journal-title":"Clin Anat."},{"issue":"5","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/00005131-199607000-00008","article-title":"Posterior approaches to the humerus: when should you worry about the radial nerve?","volume":"10","author":"Uhl","year":"1996","journal-title":"J Orthop Trauma."},{"issue":"11","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.2106\/00004623-200611000-00011","article-title":"Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study","volume":"88","author":"Cetik","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1002\/ca.22352","article-title":"Surgical anatomy of the axillary nerve branches to the deltoid muscle","volume":"28","author":"Leechavengvongs","year":"2015","journal-title":"Clin Anat."},{"issue":"4","key":"bib10-20230811","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/01241398-200207000-00006","article-title":"Predicting ulnar nerve location in pinning of supracondylar humerus fractures","volume":"22","author":"Wind","year":"2002","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/BPO.0b013e318263a3c0","article-title":"Ultrasound evaluation of ulnar nerve anatomy in the pediatric population","volume":"32","author":"Erez","year":"2012","journal-title":"J Pediatr Orthop."},{"issue":"3","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00276-009-0599-3","article-title":"Correlation between the lengths of the upper limb and cubital tunnel: potential use in patients with proximal ulnar nerve entrapment","volume":"32","author":"Tubbs","year":"2010","journal-title":"Surg Radiol Anat."},{"issue":"4","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/BPO.0000000000000129","article-title":"The medial epicondyle-ulnar nerve relation with various elbow positions in healthy children","volume":"34","author":"Y\u0131ld\u0131r\u0131m","year":"2014","journal-title":"J Pediatr Orthop."},{"issue":"10","key":"bib14-20230811","doi-asserted-by":"crossref","first-page":"4125","DOI":"10.21037\/jtd.2017.09.14","article-title":"Using the confidence interval confidently","volume":"9","author":"Hazra","year":"2017","journal-title":"J Thorac Dis."},{"issue":"2","key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med."},{"issue":"2","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00276-008-0412-8","article-title":"Surgical anatomy of the radial nerve at the elbow","volume":"31","author":"Artico","year":"2009","journal-title":"Surg Radiol Anat."},{"issue":"6","key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/S0363-5023(09)91056-5","article-title":"The superficial branch of the radial nerve: an anatomic study with surgical implications","volume":"17","author":"Abrams","year":"1992","journal-title":"J Hand Surg Am."},{"issue":"4","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"396","DOI":"10.17712\/nsj.2015.4.20150007","article-title":"Axillary nerve course and position in the fetal period. An anatomic dissection study for surgical practice","volume":"20","author":"Uluer","year":"2015","journal-title":"Neurosciences (Riyadh)."},{"issue":"1","key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s00276-016-1721-y","article-title":"Topography of the coracobrachialis muscle and the musculocutaneous nerve by muscular variation","volume":"39","author":"Oh","year":"2017","journal-title":"Surg Radiol Anat."},{"issue":"3","key":"bib21-20230811","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00276-015-1564-y","article-title":"Coracobrachialis muscle: morphology, morphometry and gender differences","volume":"38","author":"Ilayperuma","year":"2016","journal-title":"Surg Radiol Anat."},{"key":"bib22-20230811","first-page":"149","article-title":"The surgical anatomy of the radial nerve around the humerus","volume":"320","author":"Guse","year":"1995","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib23-20230811","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1007\/s11999-015-4442-3","article-title":"Elbow positioning and joint insufflation substantially influence median and radial nerve locations","volume":"473","author":"Hackl","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib24-20230811","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1002\/ca.20734","article-title":"The course and variations of the branches of the musculocutaneous nerve in human fetuses","volume":"22","author":"Uysal","year":"2009","journal-title":"Clin Anat."},{"issue":"4","key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1002\/ca.22343","article-title":"The prevalence of os acromiale: a systematic review and meta-analysis","volume":"27","author":"Yammine","year":"2014","journal-title":"Clin Anat."},{"issue":"1","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S1058-2746(09)80014-1","article-title":"Surgical anatomy of the axillary nerve","volume":"1","author":"Burkhead","year":"1992","journal-title":"J Shoulder Elbow Surg."},{"issue":"11","key":"bib27-20230811","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.injury.2003.08.008","article-title":"Anatomical considerations for percutaneous proximal humeral fracture fixation","volume":"35","author":"Kamineni","year":"2004","journal-title":"Injury."},{"issue":"2","key":"bib28-20230811","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2106\/00004623-194931020-00002","article-title":"Surgical approaches to the shoulder joint","volume":"31","author":"Abbott","year":"1949","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib29-20230811","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.jse.2008.12.001","article-title":"Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach","volume":"18","author":"Cheung","year":"2009","journal-title":"J Shoulder Elbow Surg."},{"key":"bib30-20230811","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/00003086-200004000-00032","article-title":"Radial and axillary nerves. Anatomic considerations for humeral fixation","volume":"373","author":"Bono","year":"2000","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib31-20230811","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.jhsa.2006.07.001","article-title":"The radial nerve in the brachium: an anatomic study in human cadavers","volume":"32","author":"Carlan","year":"2007","journal-title":"J Hand Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:32Z","timestamp":1787751932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00019"}},"subtitle":["A Magnetic Resonance Imaging Study"],"short-title":[],"issued":{"date-parts":[[2019,10,11]]},"references-count":30,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.00019","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,11]]}}}