Treatment outcome of tardy ulnar nerve palsy associated with traumatic cubitus valgus by supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release

Abstract

Background Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus. At present, the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus is still controversial, whether these two problems can be corrected safely and effectively in one operation is still unclear. To investigate the supracondylar shortening wedge rotary osteotomy combined with in situ tension release of the ulnar nerve in the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus. Methods Between 2012 and 2019, 16 patients who had traumatic cubitus valgus deformities with tardy ulnar nerve palsy were treated with simultaneous supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release. we compared a series of indicators of preoperative and postoperative follow-up for at least 24 months, (1) elbow range of motion; (2) the radiographic correction of the preoperative and postoperative humerus-elbow-wrist angles; (3) the static two-point discrimination and grip strength; and (4) the preoperative and postoperative DASH scores of upper limb function. The minimum follow-up was 24 months postoperative (mean, 33 months; range, 24 ~ 44 months). Results The mean ROM was improved from 107 ° preoperatively to 122 ° postoperatively (P = 0.001). The mean preoperative elbow wrist angle was 24.6 °, and the mean postoperative humerus-elbow wrist angle was 12.1 ° (P < 0.001). The average grip strength and static two-point discrimination improved from 21 kgf and 8 mm to 28 kgf and 4.0 mm (P < 0.001 and P < 0.001, respectively). The ulnar nerve symptoms were improved in all patients except one. The mean HASH score improved from 29 to 16 (P < 0.001). Conclusion Supracondylar shortening wedge rotary osteotomy combined with in situ tension release of ulnar nerve is an effective method for the treatment of traumatic cubitus valgus with tardy ulnar nerve palsy, which restored the normal biomechanical characteristics of the affected limb and improved the elbow joint function.

Massive traumatic articular bone loss of the capitulum humeri treated by costal osteochondral autograft reconstruction: A case report

“…Some studies suggest that a capitellum excision can cause a major valgus instability, especially with associated ligament injury, which can induce a tardy ulnar nerve palsy and an early osteoarthritis of the medial compartment of the elbow [ [14] , [15] , [16] ].…”

Functional outcome of tardy ulnar nerve palsy manifests after 25 years due to nonunion of lateral epicondyle left humerus treated by ulnar nerve transposition: A case report

“…Beside decompression and anterior subcutaneous of ulnar nerve to relieve the nerve compression, on the patient with concomitant cubitus valgus, other surgical management for bony procedure can be performed: distal humerus osteotomy with closed wedge osteotomy on medial side or supracondylar shortening wedge rotary osteotomy [ 2 , 9 ]. This bony procedure aims to restore the normal biomechanical characteristics of the affected limb and improve elbow joint function [ 9 ].…”