TRANSPOSITION OF THE ULNAR NERVE IN BICONDYLAR HUMERAL FRACTURES. (TYPE C)

Abstract

Aim: The purpose of the present retrospective study was to evaluate reasonable routine transposition of the ulnar nerve in bicondylar humeral fractures.

Material and method: From 1996 to 2007 112 bicondylar fractures were operated. 88 pateints (47 women and 41 men) were followed up for average 56 months. Average age was 48 (14–80) years. Open fractures were 17. Fractures were distributed by the AO classification as follows: type C1.2 – 16, C1.3 – 10, C2.1 – 22, C2.2 – 7, C2.3 – 3, C3.1 – 17, C3.2 – 8 and C3.3 -5. All fractures were operated by the AO method with dorsal approach, osteotomy of the olecranon (83 fractures) and fixation with 2 plates. In 47 cases the ulnar nerve was routinely anteriorly transposed and for the rest 41 patients transposition was not done.

Results: From 47 patients with routine anterior transposition 7 had Mc Gowan I dysfunction that was resolved in 3 months. From 41 patients without transposition 9 had a type Mc Gowan I dysfunction. There was no statistical significance between the two groups. (p> 0,05). However, 12 to 18 months later 3 patients from the group without transposition with type C1.3, C3.1 and C3.3 fractures returned with late postoperative nerve palsy Mc Gowan II and III. They were treated by neurolysis and transposition.

Conclusion: Routine anterior transposition of the ulnar nerve is not reasonable in every type of bicondylar humeral fractures. The type of the bicondylar fracture defines whether the nerve transposition is reasonable or not. In low bycondilar humeral fractures and type C3 fractures the nerve transposition is obligatory.