OTA 2008 Posters

Scientific Poster #131 Upper Extremity OTA-2008

Ulnar Nerve Function in Type 13C Distal Humerus Fractures

Amer Jawad Mirza, MD1 (n); Agel Julie, MA, ATC2 (n);
Daphne M. Beingessner, Msc, MD, FRCSC2 (a-Synthes, Zimmer);
M. Bradford Henley, MD2 (n); Douglas P. Hanel, MD2 (n); Lisa Taitsman, MD2 (n);
1Oregon Health Science University, Portland, Oregon, USA;
2Harborview Medical Center, Seattle, Washington, USA

Purpose: Our objective was to assess ulnar nerve function in the early postoperative period in patients with type 13C distal humerus fractures. Our hypothesis is that ulnar nerve mobilization and anterior transposition is not associated with increased incidence of ulnar nerve dysfunction postoperatively.

Methods: A retrospective cohort study was performed over a 6-year period. All patients sustaining AO/OTA type 13C fractures of the distal humerus were identified with an electronic orthopaedic trauma database. 123 patients met inclusion criteria and were eligible for analysis. Patient records and radiographs were reviewed pertaining to fracture subclassification (C1, C2, C3), tourniquet use, operative approach, nerve transposition, medial implant position, presence of an open fracture, and contracture release. Ulnar nerve management during operative fixation of the distal humerus was categorized as nerve mobilization without transposition, subcutaneous anterior transposition, or submuscular anterior ulnar nerve transposition. Ulnar nerve motor and sensory function was defined as normal, abnormal, or absent at time of hospital discharge, and 2-week, 6-week, 3-month, and final follow-up intervals. Statistical analysis was performed using SPSS version 14. Categorical data were analyzed using the χ2 test.

Results: 46 patients (37%) underwent anterior subcutaneous transposition of the ulnar nerve at the time of fracture fixation. Four patients (9%) in the transposition group had nerve symptoms at 3-month follow-up. The remaining 77 patients (63%) did not have an ulnar nerve transposition. 20 patients (26%) had ulnar symptoms at 3 months within this group. Ulnar nerve dysfunction did not appear to be affected by fracture classification/severity (P = 0.08), tourniquet use (P = 0.66), operative approach (P = 0.28), medial implant position (P = 0.60), or presence of an open fracture (P = 0.59).We did find an increased occurrence of nerve dysfunction at 3 months postoperatively in patients not undergoing transposition (P = 0.04). We also found an increased frequency of nerve dysfunction in patients who went on to elbow contracture release (P <0.001).

Conclusion: The role of ulnar nerve transposition as part of operative management of distal humerus fractures remains uncertain. We found a higher percentage of ulnar nerve symptoms in patients not undergoing ulnar nerve transposition at the time of definitive fracture fixation.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.