Abstract
PurposeTo compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures.MethodsThis was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery.ResultsTwenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00).ConclusionWe do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.
Highlights
The treatment of distal humerus fracture is often challenging due to their complexity and proximity to neurovascular structures [1]
Ruan et al [5] found that ulnar transposition at the time of open reduction and internal fixation (ORIF) led to substantial improvement in cases that develop ulnar nerve neuropathy
This study aimed to compare the incidence of ulnar nerve neuropathy with or without subcutaneous anterior transposition of the ulnar nerve after ORIF of distal humerus fractures
Summary
The treatment of distal humerus fracture is often challenging due to their complexity and proximity to neurovascular structures [1]. Ulnar nerve neuropathy is a common complication after ORIF of distal humerus fractures, with a mean incidence of 12.3% [3]. There is sufficient evidence supporting subcutaneous anterior transposition of the ulnar nerve in patients with pre-operative signs of ulnar neuropathy [4, 5]. In patients with no pre-operative neurological deficit, the optimal handling of the ulnar nerve at the time of ORIF of the distal humerus remains controversial. Ruan et al [5] found that ulnar transposition at the time of ORIF led to substantial improvement in cases that develop ulnar nerve neuropathy. Other studies reported no added benefit [6, 7]or even an increased risk of ulnar nerve dysfunction [8]
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