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

Vázquez, Óscar Infante; Rutgers, Marijn; Ring, David; Walsh, Michael; Egol, Kenneth A.

doi:10.1097/bot.0b013e3181e3e273

Cited by 95 publications

(57 citation statements)

References 12 publications

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“…Although meticulous radial nerve protection is emphasized in plate fixation, the 5.3% incidence of iatrogenic radial nerve palsies was slightly lower than the 10.1% reported by Vazquez et al [21]. A probable explanation of our findings and other studies [18,21] could be due to the extensive soft-tissue stripping that is involved in the dual-plating technique, thereby resulting in a longer operation time and a high rate of tenderness. Equally important, other studies [9,11] using the single-plating technique for diaphyseal humeral fractures have reported good clinical outcome.…”

Section: Discussioncontrasting

confidence: 54%

“…The 105–140 min range of operation time in our study was shorter than the 150–215 min in the studies by Soon et al [19] and Reising et al [20]. Although meticulous radial nerve protection is emphasized in plate fixation, the 5.3% incidence of iatrogenic radial nerve palsies was slightly lower than the 10.1% reported by Vazquez et al [21]. A probable explanation of our findings and other studies [18,21] could be due to the extensive soft-tissue stripping that is involved in the dual-plating technique, thereby resulting in a longer operation time and a high rate of tenderness.…”

Section: Discussioncontrasting

confidence: 53%

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Surgical Treatment of Adult Extra-Articular Distal Humeral Diaphyseal Fractures Using an Oblique Metaphyseal Locking Compression Plate via a Posterior Approach

Qing

Wang²,

Wang³

et al. 2011

Med Princ Pract

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Objective: The purpose of this study was to evaluate the feasibility and clinical outcome of using an oblique AO (Association for the Study of Internal Fixation) metaphyseal locking compression plate (MLCP) in the treatment of adult extra-articular distal humeral diaphyseal fractures via a posterior approach. Subjects and Methods: A series of 19 cases of adult extra-articular distal humeral diaphyseal fractures were surgically treated using an MLCP and lag screws, if necessary, via a posterior approach. All patients were followed for a mean time of 16.6 months (range from 12 to 20 months). The patients were followed up to 1 year, and radiological assessment was performed to observe fracture reduction and healing. Functional outcome was measured including the range of motion of the shoulder and elbow, by the University of California at Los Angeles and the Mayo Elbow Performance Score. Results: The incidence of iatrogenic radial nerve palsy was 5%. There was no failure of internal fixation and no infection. After 1 year, the University of California at Los Angeles scoring system rated 12 (63.2%) patients as excellent results. The Mayo elbow performance scoring system rated 10 (84%) cases as excellent results. Completely normal alignment was presented in 16 cases. Conclusion: Following surgical treatment of adult extra-articular distal humeral diaphyseal fractures, an oblique MLCP applied via a posterior approach achieved an adequate internal fixation and obtained an excellent functional outcome.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussioncontrasting

confidence: 53%

Surgical Treatment of Adult Extra-Articular Distal Humeral Diaphyseal Fractures Using an Oblique Metaphyseal Locking Compression Plate via a Posterior Approach

Qing

Wang²,

Wang³

et al. 2011

Med Princ Pract

View full text Add to dashboard Cite

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“…There were no cases of secondary radial nerve palsy. We had only one case (5 %) of post-operative ulnar neuropathy, an incidence which is lower than the numbers reported elsewhere in the literature [23]. The literature on this topic remains somewhat unclear, and the management of the ulnar nerve following ORIF of a distal humerus fracture in patients who had normal findings on a preoperative neurological examination remains an unresolved issue.…”

Section: Discussionmentioning

confidence: 61%

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

Capo

Debkowska

Liporace

et al. 2013

International Orthopaedics (SICOT)

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Purpose The locking compression extra-articular distal humerus plate (EADHP) is an anatomically shaped, angular stable single-column fixation system for distal third humerus fractures. The purpose of this retrospective study was to evaluate clinical and radiographic outcomes after open reduction and internal fixation of distal humerus fractures with this device. Methods Twenty-one consecutive patients with distal humerus fractures were treated with the EADHP system between February 2006 and June 2012. Of these, 19 were clinically and radiographically evaluated after a mean follow-up of 10.4 months. Follow-up assessment included anteroposterior and lateral radiographs, assessment of range of motion (ROM), pain according to a visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results All fractures demonstrated satisfactory reduction and healing at an average of 7.3 months. One patient showed postoperative sensory ulnar neuropathy that recovered completely, and nine patients had a preoperative radial nerve palsy, which recovered spontaneously following exploration and plating. Mean post-operative ROM was as follows: flexion 126°, extension −7°, pronation 82°and supination 83°. The VAS score was zero points in eight patients, while the mean DASH score was 25.8 points.Conclusions For extra-articular distal humerus fractures, including high-energy injuries often seen in gunshot wounds or motor vehicle injuries, the anatomically shaped angular stable single-column plate provides satisfactory clinical and radiographic results and serves as a valuable tool in the treatment of these injuries.

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“…Controversy remains regarding postoperative management of the ulnar nerve at the time of fixation [4,12,13], but it is generally accepted that it should be transposed anteriorly when the patient exhibits pre-operative ulnar nerve symptoms [3] because if left in place it will be in contact with the fixation performed and can be irritated by it during motion. In our patients the nerve was routinely transposed subcutaneously anterior to avoid contact with the tension band.…”

Section: Discussionmentioning

confidence: 99%

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Allende

Gutiérrez

Savoy

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the objective and subjective results achieved after double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions in adults. Methods Nine patients presenting six fractures and three nonunions of the distal humerus, treated with double tension band wiring between 1998 and 2011, were retrospectively evaluated. Two fractures were type A2 and four type A3, and the nonunions were oligotrophic; all nine lesions had a supracondylar intracapsular transverse orientation, that passed through the olecranon fossa, in a direction parallel to the joint line, and they compromised both columns of the distal humerus. Patient's age averaged 70 years (range, 56-82). Results Follow-up averaged 24.6 months (range, 12-53). All fractures and nonunions united; there were no infections, elbow stiffness or heterotopic bone formations. DASH score at final follow-up averaged 14.2 points (range, 4-22). The analog scale of pain averaged 1.1 points (range, 0-3). Elbow range of motion averaged 100°(range, 100-120°). Flexion averaged 123°(range, 115-130°) and elbow extension loss averaged 15.5°(range, 10-25°).Conclusions The results achieved with double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions are comparable to the results that can be expected when using other available fixation methods; this technique is faster, less demanding and cheaper, and surgeons should have it in mind when leading with these particular types of distal humerus fractures and nonunions.

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

Cited by 95 publications

References 12 publications

Surgical Treatment of Adult Extra-Articular Distal Humeral Diaphyseal Fractures Using an Oblique Metaphyseal Locking Compression Plate via a Posterior Approach

Surgical Treatment of Adult Extra-Articular Distal Humeral Diaphyseal Fractures Using an Oblique Metaphyseal Locking Compression Plate via a Posterior Approach

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

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