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Which of the following has been associated with transposition of the ulnar nerve following fixation of an intra-articular distal humerus fracture?
Decreased incidence of ulnar neuropathy
Increased incidence of ulnar neuritis
Increased infection rate
Faster return to function
Decreased medial hardware irritation
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Transposition of the ulnar nerve after ORIF of an intra-articular distal humerus fracture has been shown to be associated with an increased incidence of ulnar neuritis.
Ulnar neuritis is a common complication associated with fixation of distal humerus fractures. The most common etiology of ulnar neuritis include irritation from the initial trauma or at the time of surgical intervention. Direct comparison of similar groups with and without transposition indicate that transposition of the ulnar nerve MAY NOT be helpful in preventing the development of ulnar neuritis after distal humerus fractures.
Chen et al. retrospective reviewed the incidence of postoperative ulnar nerve dysfunction with or without ulnar nerve transposition. That found that the symptoms of ulnar neuritis occurred almost four times more frequently in the transposition group (16 of 48 [33%]) compared to the group without transposition (eight of 89 [9%]; P = 0.0003).
Vazquez et al. retrospectively reviewed 70 patients to determine the incidence of ulnar nerve dysfunction after open reduction and internal fixation of distal humerus fractures. Seven patients (10%) had neuropathy symptoms in the immediate postoperative period from fixation of an intra-articular distal humerus fracture. Four were transposed (P = 0.67). They concluded that no treatment factors, including nerve transposition, were found to increase the risk of intra-operative ulnar nerve injury.
Illustration A shows transposition of the ulnar nerve anterior to the medial epicondyle.
Answer 1: Transposition of the ulnar nerve increases (or does not affect) the incidence of ulnar nerve neuropathy. No literature supports a decreased incidence of neuropathy.
Answer 3: There is no association between ulnar nerve transposition and infection rates.
Answer 4: Transposition of the ulnar nerve increases ulnar neuritis, which has been shown to slow return of elbow function.
Answer 5: There is no known association between ulnar nerve transposition and medial hardware irritation.
Chen RC, Harris DJ, Leduc S, Borrelli JJ, Tornetta P, Ricci WM
J Orthop Trauma. 2010 Jul;24(7):391-4. PMID: 20577067 (Link to Abstract)
Chen, JOT 2010
Vazquez O, Rutgers M, Ring DC, Walsh M, Egol KA.
J Orthop Trauma. 2010 Jul;24(7):395-9. PMID: 20577068 (Link to Abstract)
Vazquez, JOT 2010
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Video shows posterior approach to elbow with osteotomy