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Decreased incidence of ulnar neuropathy
31%
1490/4806
Increased incidence of ulnar neuritis
42%
2034/4806
Increased infection rate
1%
40/4806
Faster return to function
34/4806
Decreased medial hardware irritation
25%
1183/4806
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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. Incorrect Answers: 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.
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