title: Is routine ulnar nerve transposition necessary in open release of stiff elbows? Our experience and a literature review.
abstract: OBJECTIVE
  Prophylactic release of the ulnar nerve to reduce the incidence of postoperative nerve symptoms in stiff elbows has been recommended. However, the necessity for routine anterior transposition remains unclear. In this study, we aim to gain an insight into the value of routine transposition in open release of stiff elbows.
  
  
  METHODS
  We retrospectively reviewed 94 patients suffering from elbow stiffness with no pre-operative ulnar nerve symptoms. Simple decompression (with in situ decompression or epicondylectomy) and subcutaneous anterior transposition were chronologically performed in 53 and 37 patients, respectively. Another four patients were treated by a single lateral approach with no intervention of the ulnar nerve. Pre- and postoperative range of motion and incidence of ulnar nerve symptoms were recorded. The function of ulnar nerve was measured by Amadio rating scale.
  
  
  RESULTS
  The incidence of ulnar nerve dysfuction was 18.9% (ten of 53) and 8.1% (three of 37) in the simple decompression and transposition groups, respectively. The mean Amadio scores were 7.62 and 8.22, respectively. All these data showed a statistically significant difference (P < 0.05). In the lateral approach group, 50 % (two of four) of patients developed nerve symptoms with a mean Amadio score of 6.50.
  
  
  CONCLUSIONS
  The transposition group exhibited a superior nervous outcomes compared with the simple decompression group. No comparison was conducted between the transposition and lateral approach groups because of too few patients in the latter. According to related literature and our experience, we conclude that routine transposition is necessary to prevent postoperative nerve symptoms.
authors.affiliation: Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Shuai
authors.forename: Yan
authors.initials: Y
authors.lastname: Hede
authors.forename: Liu
authors.initials: L
authors.lastname: Shen
authors.forename: Ouyang
authors.initials: O
authors.lastname: Yuanming
authors.forename: Ruan
authors.initials: R
authors.lastname: Hongjiang
authors.forename: Fan
authors.initials: F
authors.lastname: Cunyi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019299:Decompression, Surgical; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery* / Q000637:transplantation; D020424:Ulnar Neuropathies / Q000517:prevention & control; D055815:Young Adult
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