Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures?
OBJECTIVE
The purpose of this study was to compare the incidence of ulnar neuritis with and without ulnar nerve transposition during open reduction and internal fixation (ORIF) of distal humerus fractures.


METHODS
Multicenter retrospective cohort series.


METHODS
: Two Level I trauma centers.


METHODS
Two cohorts were identified: 89 patients (mean age, 48.6 years) who had not undergone an ulnar nerve transposition and 48 patients (mean age, 43.2 years) who had undergone a transposition during ORIF of a distal humerus fracture (Orthopaedic Trauma Association 13A or 13C).


METHODS
All patients underwent ORIF of a distal humerus fracture with or without anterior subcutaneous ulnar nerve transposition based on surgeon preference.


METHODS
Presence or absence of ulnar neuritis (ulnar-sided paresthesias, numbness, or intrinsic weakness) or reoperation related to ulnar nerve symptoms.


RESULTS
: Average follow up was 9.6 months in the transposition group and 16.0 months in the nontransposition group. Transposition of the ulnar nerve was found to be an independent variable associated with ulnar neuritis (P < 0.001). The incidence of ulnar neuritis was 33% (16 of 48) with transposition and 9% (eight of 89) without transposition (P = 0.0003). Of the patients with ulnar neuritis, one patient in the nontransposition group (1%) and two patients in the transposition group (4%) required additional surgery specifically related to the ulnar nerve. One patient who had undergone transposition developed chronic motor and sensory denervation.


CONCLUSIONS
Patients who underwent ulnar nerve transposition at the time of ORIF of distal humerus fractures had almost four times the incidence of ulnar neuritis than those without transposition. We do not recommend routine transposition of the ulnar nerve at the time of ORIF of distal humerus fractures.
Chen
Ryan C
RC
Washington University School of Medicine, St. Louis, MO, USA.
Harris
David J
DJ
Leduc
Stephane
S
Borrelli
Joseph J
JJ
Tornetta
Paul
P
Ricci
William M
WM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*; D020424:Ulnar Neuropathies / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult