The role of ulnar nerve subcutaneous anterior transposition during open reduction and internal fixation of distal humerus fractures: a retrospective cohort study

Ahmed, Abdulaziz F.; Parambathkandi, Ashik Mohsin; Kong, Wai Jing Geraldine; Salameh, Motasem; Mudawi, Aiman; Abousamhadaneh, Maamoun; Abuodeh, Yousef; Ahmed, Ghalib

doi:10.1007/s00264-020-04745-0

Cited by 12 publications

(7 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The following were considered to have potentially confounding factors and were therefore excluded: bilateral elbow injuries due to the risk that they will distort triceps strength measurements as triceps strength is quantified as a comparison of the contralateral side (one patient); open fracture, a prognostic factor in itself, as it can alter management and has been shown to have a significant impact on functional outcomes (five); patients with any neural deficiency incurred prior to surgery due to the risk that the deficiency might confuse our findings (two). 15,20,48,49 We believe the only contraindication to the TOFS approach are capitellar and trochlear shear fractures. A retrospective review of our prospectively kept surgical database to identify all patients undergoing this approach was performed.…”

Section: Methodsmentioning

confidence: 88%

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

et al. 2022

View full text Add to dashboard Cite

BACKGROUND: We aimed to assess functional and clinical outcomes of patients who underwent open reduction and internal fixation of distal intra-articular fractures of the humerus through a previously undescribed approach through the triceps tendon, called the triceps-off, transfascial sleeve (TOFS) approach METHODS: We conducted an ambispective cohort study of ten patients who underwent open reduction and internal fixation of the distal humerus through the TOFS approach at a tertiary hospital between March 2016 and January 2019. Patients were identified from the prospectively kept surgical database. All had AO type C fractures of the distal humerus. The mean age was 36.7 ± 14.9 years (range 19-68). The assessment consisted of a review of their hospital records, range of motion, triceps strength, ultrasound evaluation of triceps tendon integrity, X-rays for union rates and adequacy of reduction, and DASH scores RESULTS: The mean time of follow-up was 10.8 ± 4.7 months (range 6-19). The mean arc of motion was 114.7 ± 25.1 degrees (range 80-150). There was a decrease in mean triceps muscle strength compared to the uninjured side: 66% at 45° of flexion, 70% at 90° and 86% at 120° of elbow flexion. The mean DASH score was 15.7 ± 8.9, indicating mild residual impairment (range 5-31). The DASH score had a strong correlation (r = 0.71; p < 0.05) with the follow-up period. All tendons were intact on ultrasound evaluation. One patient had deep surgical site infection, treated with surgical debridement, antibiotics and plate removal with resolution of sepsis and healing. All fractures united by six months CONCLUSION: TOFS is a successful surgical approach for reduction and fixation of AO type C intra-articular distal humerus fractures, with excellent tendon healing rates. It is, however, associated with mild residual functional impairment and residual triceps weakness Level of evidence: Level 4

show abstract

Section: Methodsmentioning

confidence: 88%

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Our UNC method does not allow anterior transposition. Ahmed et al and Meinberg et al [ 2 , 6 ] reported a 4.0- to 4.8-fold increase in postoperative ulnar neuropathy when anterior transposition was performed during fixation of distal humerus fractures. Chander et al [ 15 ] also reported that when nerve dissection was performed intraoperatively but without anterior transposition, only mild disability occurred in 3 of 41 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although anterior transposition is often used to prevent neuropathy, a previous meta-analysis showed no significant association between the performance of anterior transposition and the incidence of ulnar neuropathy [ 1 ]. Other authors reported no preventive effect of anterior transposition but instead found that anterior transposition was associated with a higher incidence of ulnar neuropathy [ 2 ]. These findings suggest that another factor, different from the presence or absence of anterior transposition, may be involved in the development of postoperative ulnar neuropathy.…”

Section: Introductionmentioning

confidence: 99%

The Novel Ulnar Nerve Coverage Method Which Has the Potential to Prevent the Postoperative Ulnar Neuropathy after Plate Fixation of Distal Humerus Fractures: Three Case Reports

Shibayama,

Yamaga,

Sugawara

et al. 2023

Case Reports in Orthopedics

View full text Add to dashboard Cite

Introduction. Postoperative ulnar neuropathy is still an unresolved complication in patients undergoing plate fixation of distal humerus fractures. We hypothesized that decreased blood flow to the ulnar nerve due to intraoperative procedures is an important factor in the development of postoperative ulnar neuropathy. We herein report three cases of distal humerus fractures in which the soft tissues surrounding the ulnar nerve were preserved as much as possible and finally not transferred anteriorly. Case Presentation. A 76-year-old woman, 82-year-old woman, and 34-year-old woman underwent plate fixation for distal humerus fractures. None of the patients developed postoperative ulnar neuropathy, and there were no complaints of numbness after postoperative day 1. Nerve conduction studies were performed after 3 months postoperatively and revealed that the motor nerve conduction velocities and compound motor nerve action potentials of the ulnar nerve in two of the three patients were higher than those of the noninjured side. In one of the three patients, these values were slightly lower than those of the noninjured side. All three patients achieved bony union after several months postoperatively. Conclusions. We obtained good outcomes with the ulnar nerve coverage method for preventing postoperative ulnar neuropathy in patients with distal humerus fractures. Preservation of blood flow to the ulnar nerve was considered important, and anatomical repositioning of the ulnar nerve after plate fixation has the potential to prevent adhesion between the ulnar nerve and the plate.

show abstract

“…Ulnar nerve contusion, laceration by sharp bony fragments, and hematoma are the causes due to injury. Iatrogenic causes of ulnar nerve injury include exposure and mobilization from its bed, anterior transposition [ 11 ] excessive retraction or inadvertent injury during surgical exposure, fracture manipulation, or implant irritation [ 12 ]. Post-operative swelling and hematoma formation contribute to compression of the ulnar nerve.…”

Section: Discussionmentioning

confidence: 99%

A New Technique of Fixing Intra-articular Fractures of the Distal Humerus without Exposing the Ulnar Nerve by Posterior Approach

Pappu¹,

Vavilalaa²,

Reddy³

et al. 2022

JOCR

View full text Add to dashboard Cite

Introduction: Distal humerus fractures constitute around 0.2 to 7% of all fractures, 30% of all umerus fractures, most common in young adults, are due to high energy trauma and in old age due to osteoporosis. A common step in all currently available approaches is to identify the ulnar nerve, expose, mobilise, and retract this from its surrounding bed or in situ release. Ulnar neuropathy is either observed immediately after surgery or delayed up to one year after surgery. We are describing a new posterior approach for intra-articular distal humerus fractures, where identification and retraction of the ulnar nerve are not required to fix the intra-articular fractures of the distal humerus, thereby avoiding injury to the ulnar nerve. Material and Methods: Seven patients with AO type B and C were treated using our new ulnar nerve-sparing approach between January 2017 and December 2019. Postoperatively, all the patients have been examined for ulnar neuropathy symptoms. Results: We have no ulnar nerve neuropathy either in the post-operative period or at 2 years follow-up (five cases were followed up for 2 years and two patients lost to follow-up after 6 months). At the end of 2 years, the mean range of motion achieved at elbow was 134°. The mean oxford elbow score was 45.2 (42–47). Heterotopic ossification and infection were not found in our cases. Conclusion: Our ulnar nerve-sparing approach for intra-articular fractures of distal third humerus by posterior approach helps in fixing articular fractures of distal humerus without exposing ulnar nerve during surgery without compromising on the exposure of fracture for fixation, thus reducing the chances of ulnar nerve injury and post-operative neuropathy.

show abstract

The role of ulnar nerve subcutaneous anterior transposition during open reduction and internal fixation of distal humerus fractures: a retrospective cohort study

Cited by 12 publications

References 13 publications

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

The Novel Ulnar Nerve Coverage Method Which Has the Potential to Prevent the Postoperative Ulnar Neuropathy after Plate Fixation of Distal Humerus Fractures: Three Case Reports

A New Technique of Fixing Intra-articular Fractures of the Distal Humerus without Exposing the Ulnar Nerve by Posterior Approach

Contact Info

Product

Resources

About