Sat., 10/18/08 Upper Extremity, Paper #69, 4:09 pm OTA-2008
Is Ulnar Nerve Transposition Necessary during Open Reduction and Internal Fixation of Distal Humerus Fractures?
Ryan C. Chen, MD1 (n); David J. Harris, MD2 (n); Joseph J. Borrelli, Jr, MD3 (a-AO, Biomet,
KCI, Sanofi-Aventis; Smith + Nephew, Stryker, Synthes, Inc., Wyeth, Zimmer;
a,e-Wright Medical Technology, Inc.; e-Pfizer);
Paul Tornetta, III, MD2 (c-Lippincott; a,c,e-Smith + Nephew);
William M. Ricci, MD1 (a,b-AO, Synthes; a,b,c,e-Smith + Nephew; a,b,e-Wright Medical
Technology, Inc.; e-OrthoVita);
1Washington University School of Medicine, St. Louis, Missouri, USA;
2Boston University Medical Center, Boston, Massachusetts, USA;
3University of Texas Southwestern, Dallas, Texas, USA
Background: There is no consensus regarding whether anterior transposition of the ulnar nerve is necessary at the time of surgical stabilization of bicolumnar distal humerus fractures. The purpose of this study was to compare the incidence of ulnar neuritis with and without ulnar nerve transposition following open reduction and internal fixation (ORIF) of distal humerus fractures.
Methods: A multicenter analysis identified a study group consisting of 103 patients who had not undergone an ulnar nerve transposition (mean age = 47 years) and a control group of 21 patients (mean age = 52 years) who had undergone a transposition during ORIF of a distal humerus fracture (OTA 13A or 13C). Decision for transposition was based on surgeon preference rather than fracture pattern. Operative reports and clinic notes were retrospectively analyzed.
Results: Average follow-up was 12 months in the transposition group and 15 months in the nontransposition group. Almost twice as many patients with transposition (4 of 21, 19%) developed symptoms of ulnar neuritis than those without transposition (11 of 103, 11%). Of the patients with ulnar neuritis, three patients in the nontransposition group subsequently required a neurolysis and none of the patients in the transposition group required further surgery.
Conclusion: Patients who underwent ulnar nerve transposition at the time of ORIF of distal humerus fractures had twice 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.
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.