Fate of the Ulnar Nerve After Operative Fixation of Distal Humerus Fractures

• Published in: Journal of orthopaedic trauma Vol. 24; no. 7; pp. 395 - 399
• Main Authors: Vazquez, Oscar, Rutgers, Marijn, Ring, David C, Walsh, Michael, Egol, Kenneth A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-07-2010; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bone Plates; Bone Screws; Cohort Studies; Diseases of the osteoarticular system; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Humeral Fractures - surgery; Incidence; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Retrospective Studies; Risk Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Ulnar Nerve - injuries; Ulnar Nerve - physiopathology; Ulnar Neuropathies - epidemiology; Ulnar Neuropathies - etiology; Young Adult; Nervous system diseases; Motor system disorder; Cubital nerve; distal humerus fracture; Diseases of the osteoarticular system; ulnar nerve; Fracture; Trauma; Transposition; Fixation; Orthopedics; Complication; palsy; Paralysis; Neurological disorder; Humerus
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/BOT.0b013e3181e3e273

OBJECTIVES:It is well recognized that operative treatment of a fracture of the distal humerus requires handling of the ulnar nerve, which can cause nerve dysfunction; however, the incidence of postoperative ulnar nerve dysfunction is not well studied. Our purpose was to determine the incidence of ulnar nerve dysfunction after open reduction and internal fixation of distal humerus fractures and identify factors associated with its development.
DESIGN:Retrospective cohort study from two university-based institutions.
PATIENTS:The medical records of 69 patients with a minimum of 12 months follow-up (median, 15 months; range, 12-72 months) after open reduction and plate and screw fixation of a bicolumnar fracture of the distal humerus (Orthopaedic Trauma Association Types 13A and C) that did not have preoperative ulnar nerve dysfunction were reviewed retrospectively.
INTERVENTION:Surgical repair of a distal humerus fracture with or without ulnar nerve transposition.
MAIN OUTCOMES:Ulnar nerve function was graded immediately postoperatively and at final follow-up according to a modified system of McGowan. Those with and without ulnar neuropathy were analyzed for differences in final position of the nerve (anterior versus in the cubital tunnel), open injury, multiple procedures, ipsilateral injury, and demographic factors.
RESULTS:The incidence of immediately postoperative ulnar nerve dysfunction documented in the medical record was seven of 69 patients (10.1%) (McGowan grades1 [57%], 2 [43%], 3 [0%]). The incidence of ulnar nerve dysfunction at final follow-up was 16% (11 of 69 patients) (McGowan grades1 [72%], 2 [28%], 3 [0%]). No demographic, injury, or treatment factors were associated with a risk of postoperative ulnar nerve dysfunction.
CONCLUSION:There is a substantial incidence of postoperative ulnar nerve dysfunction after open reduction and plate and screw fixation of the distal humerus, which is likely underestimated by this retrospective analysis. Prospective studies using careful preoperative nerve evaluation and systematic postoperative nerve assessment are likely to identify an even higher incident of postoperative ulnar nerve dysfunction. Transposition was not protective in this analysis.