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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

We retrospectively reviewed a consecutive series of 180 patients with acute DHF treated either with ORIF, TEA, or EHA.

Research results

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.

Research conclusions

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.

Research perspectives

Further research may be needed to confirm these results and explore other potential risk factors for ulnar nerve affection in DHF patients.