Complication Rates of Cubital Tunnel Surgery: In situ Cubital Tunnel Release Compared with Ulnar Nerve Transposition: Level 3 Evidence

Abstract

There is no financial information to disclose. The purposes of this study are to determine the rate and types of complications of in situ cubital tunnel release compared with ulnar nerve transposition. Our null hypothesis is that complication rates are the same after in situ cubital tunnel release and ulnar nerve transposition. An IRB-approved retrospective cohort study was performed over a 5-year period at a single institution. The hospital medical records database was queried using Common Procedural Terminology code for all patients who underwent open cubital tunnel release from August 2008 to July 2013, yielding 426 patients who underwent cubital tunnel surgery. Application of exclusion criteria of acute trauma, revision surgery, neoplasm, age less than 18, misdated procedure, miscoded procedure, insufficient records, and non-study surgeon resulted in 340 patients who underwent cubital tunnel decompression, including 225 in situ cubital tunnel releases and 115 ulnar nerve transpositions. Computerized medical records were analyzed for surgical complications. Of 340 cubital tunnel surgeries performed, 19 were noted to have a complication by final follow-up (5.6%). There were 8 complications out of 225 in situ cubital tunnel releases (3.6%), including 3 cases of ulnar nerve instability (1.3%), 2 cases of persistent or recurrent cubital tunnel syndrome (0.9%) treated with ulnar nerve transposition, 2 cases of postoperative infection (0.9%) treated with antibiotics and wound care, and 1 case of a postoperative seroma (0.4%) not requiring reoperation. There were 11 complications out of 115 ulnar nerve transpositions (9.6%), including 9 cases of persistent or recurrent cubital tunnel syndrome (7.8%), 8 of which were treated with revision ulnar nerve transposition, 1 case of postoperative infection (0.9%) treated with surgical debridement, and 1 case of MACN injury (0.9%) repaired intraoperatively. The revision surgery rate was 4.7% overall, 1.8% for in situ cubital tunnel release and 7.8% for ulnar nerve transposition. Ulnar nerve transposition was associated with increased rates of complication (P = 0.02) and revision surgery (P = 0.01). •The short-term complication rates of cubital tunnel surgery are low (5.6%), but higher for ulnar nerve transposition (9.6%) than in situ cubital tunnel release (3.6%), P = 0.02.•The revision surgery rate after cubital tunnel surgery was 4.7% overall, but higher for ulnar nerve transposition (7.8%) than in situ cubital tunnel release (1.8%), P = 0.01.•The most common complications following in situ cubital tunnel release are ulnar nerve instability (1.3%), persistent or recurrent cubital tunnel syndrome (0.9%), and infection (0.9%).•The most common complication following ulnar nerve transposition is persistent or recurrent cubital tunnel syndrome (7.8%).