Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.526
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
Ulnar nerve affection following surgical treatment of distal humerus fractures (DHF) is a well-recognized complication. Surgery of the ulnar nerve may consist of either subcutaneous anterior transposition or in situ release retaining the nerve in its original position. However, which method should be preferred is debatable. We believe that in situ release and protection of the ulnar nerve without transposition produced a low prevalence of postoperative ulnar nerve affection for both Open reduction and internal fixation (ORIF), Total elbow arthroplasty, (TEA) and elbow hemiarthroplasty (EHA) surgeries of distal humerus fracture. In contrast to the previously published studies, we were able to compare the risk of ulnar nerve affection after ORIF, EHA, and TEA.
Several retrospective studies have reported a risk of ulnar nerve affection subsequent to surgery for distal humeral fractures (DHF), where either the nerve was anteriorly transposed or released in situ. However, these studies have arrived at differing conclusions. As a result, we were motivated to conduct a detailed investigation into the prevalence of per- and post-operative ulnar nerve affection when the nerve is released in situ. To this end, we excluded patients who were presented with pre-operative ulnar nerve affection, as well as those who were afflicted with postoperative infection.
To report the risk of ulnar nerve affection after surgeries (ORIF, TEA, and EHA) for acute DHF when the ulnar nerve is in situ released without transposition.
We retrospectively reviewed a consecutive series of 180 patients with acute DHF treated either with ORIF, TEA, or EHA.
Our study found a low risk of ulnar nerve affection following surgical treatment for acute DHF when the ulnar nerve was released in situ without nerve transposition. Of the 180 patients included in the study, only nine reported mild ulnar nerve affection and two reported severe affection according to the McGowen Classification Score. The study also found that the type of surgery (ORIF, EHA, or TEA) did not significantly affect the risk of ulnar nerve affection. Three out of 69 patients treated with ORIF had mild temporary ulnar nerve affection, while seven out of 111 patients treated with arthroplasty (67 EHA, 44 TEA) had mild ulnar nerve affection and one had severe persistent affection.
The findings of our study suggest that releasing the ulnar nerve in situ without transposition during surgical treatment of acute DHF may help minimize the risk of ulnar nerve affection, regardless of the type of surgery performed.
Further research may be needed to confirm these results and explore other potential risk factors for ulnar nerve affection in DHF patients.