Purpose
To compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures.
Methods
This was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery.
Results
Twenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00).
Conclusion
We do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.
Compartment syndrome secondary to pseudoaneurysm formation following surgical stabilization of tibia shaft fracture is a rare entity. Early recognition as early as possible can prevent associated morbidities and significant disabilities by surgical decompression of leg compartments. A 56-year-old male patient presented to our clinic during his routine postsurgical follow-up with a progressive painful right leg swelling, which progressed over 2 months following right tibia shaft stabilization secondary to a road traffic accident. The patient underwent further investigation of this swelling. After infection was ruled out, it was found to be a pseudoaneurysm. Following diagnosis, the patient underwent endovascular coiling of the pseudoaneurysm feeding vessel, and surgical decompression with evacuation of the hematoma was performed. Multiple causes for compartment syndrome do exist; pseudoaneurysm is different from other causes in that it has a feeding vessel. Careful preoperative endovascular coiling is important to prevent and control intraoperative bleeding, which prevents further development of compartment syndrome. Moreover, aggressive postoperative physiotherapy should be avoided in the early period, especially soft tissue manipulation, as this might be a leading cause for the development of such a condition.
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