Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2023; 14(7): 526-532
Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.526
Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ
Mustafa Al-Gburi, Ali Al-Hamdani, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen
Mustafa Al-Gburi, Ali Al-Hamdani, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen, Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
Author contributions: Al-Gburi M, Al-Hamdani A, Rasmussen JV, and Olsen BS made substantial contributions to the conception and design, the analysis and interpretation of data, and the drafting and revising of the article; and all authors approved the final version of the manuscript for publishing.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital.
Informed consent statement: According to the local Danish medical law, the study did not require informed consent from the patients in such a quality control study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mustafa Al-Gburi, Doctor, MD, Doctor, Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, 12 Gentofte Hospitalsvej, Hellerup 2900, Gentofte, Denmark. mustafa.hamid.hussein.al-gburi@regionh.dk
Received: February 23, 2023
Peer-review started: February 23, 2023
First decision: May 9, 2023
Revised: May 19, 2023
Accepted: May 26, 2023
Article in press: May 26, 2023
Published online: July 18, 2023
Processing time: 144 Days and 12.7 Hours
Abstract
BACKGROUND

Adult distal humeral fractures (DHF) comprise 2%-5% of all fractures and 30% of all elbow fractures. Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures. Open reduction and internal fixation (ORIF) are often the treatment of choice, but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality. Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.

AIM

To report the risk of ulnar nerve affection after surgery for acute DHFs.

METHODS

We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF, elbow hemiarthroplasty (EHA) or total elbow arthroplasty (TEA) between January 2011 and December 2019. In all cases, the ulnar nerve was released in situ without anterior transposition. We used our institutional database to review patients’ medical records for demographics, fracture morphology, type of surgery and ulnar nerve affection immediately; records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up. Twenty-nine percent patients were excluded due to pre- or postoperative conditions. Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score. A total of 210 patients were eligible for interview, but 13 patients declined participation and 17 patients failed to respond. Thus, 180 patients were included.

RESULTS

Mean age at surgery was 64 years (range 18-88 years); 121 (67.3%) patients were women; 59 (32.7%) were men. According to the AO/OTA classification system, we recorded 47 patients with type A3, 55 patients with type B and 78 patients with type C fractures. According to the McGowen Classification Score, mild ulnar nerve affection was reported in nine patients; severe affection, in two. A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection. In all, 111 patients were treated with arthroplasty (67 EHA, 44 TEA) of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection. No further treatment was provided.

CONCLUSION

The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition, independently of the treatment provided.

Keywords: Humeral fracture; Arthroplasties; Internal fixation; Ulnar nerve affection; In situ release

Core Tip: Ulnar nerve affection after surgery for distal humerus fractures (DHF) is a known complication. We retrospectively reviewed a consecutive series of 180 patients with acute DHF treated either with open reduction and internal fixation (ORIF), total elbow arthroplasty (TEA) or elbow hemiarthroplasty (EHA). According to the McGowan Classification Score, 11 patients reported ulnar nerve affection symptoms (nine patients with mild affection and two patients with severe affection). The risk of ulnar nerve affection after surgery for acute DHF is low when the ulnar nerve is released in situ without transposition, independently of the treatment provided (i.e., ORIF, EHA, or TEA).