Skip to main content
SpringerLink
Log in

Efficacy of Combined Osteotomy and Ulnar Nerve Transposition for Cubitus Valgus With Ulnar Nerve Palsy in Adults

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus deformity. Whether both problems can be corrected together, safely and effectively, in a single surgical procedure remains unknown.

Questions/purposes

We therefore reviewed a patient cohort having this combined surgery and compared preoperatively and at a minimum of 24 months postoperatively (1) active elbow ROM; (2) radiographic correction of the cubitus valgus deformity of the preoperative and postoperative humerus-elbow-wrist angles and the medial prominence index; (3) ulnar nerve function through grip strength and static two-point discrimination; and (4) overall upper limb disability by the DASH score.

Methods

Between 2004 and 2009, 13 patients who had traumatic cubitus valgus deformities and tardy ulnar nerve palsy (Dellon’s Grade III) were treated with simultaneous supracondylar dome osteotomy and anterior transposition of the ulnar nerve and were reviewed retrospectively. The minimum followup was 24 months (mean, 33 months; range, 24–52 months).

Results

The mean preoperative ROM was 16° to 124° and mean postoperative ROM was 10° to 126°. All osteotomies healed uneventfully. The mean postoperative humerus-elbow-wrist angle was 11° and the average correction was 24°. None of the patients had recurrence of the deformity or residual prominence of the medial condyle at the last followup. The mean grip strength and static two-point discrimination improved from 20 kg of force and 6.9 mm to 27 kg of force and 4.0 mm (p = 0.002 and p = 0.004, respectively). Subjective ulnar nerve symptoms improved in all but one patient. The mean DASH score improved from 29 points to 16 points (p = 0.001).

Conclusion

A combined supracondylar dome osteotomy and anterior transposition of the ulnar nerve is effective in correcting posttraumatic cubitus valgus deformity and its associated ulnar nerve palsy.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3A–C
Fig. 4A–C

Similar content being viewed by others

References

  1. Barrios C, Ganoza C, de Pablos J, Canadell J. Posttraumatic ulnar neuropathy versus non-traumatic cubital tunnel syndrome: clinical features and response to surgery. Acta Neurochir (Wien). 1991;110:44–48.

    Article  PubMed  CAS  Google Scholar 

  2. Caputo AE, Watson HK. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg Am. 2000;25:544–551.

    Article  PubMed  CAS  Google Scholar 

  3. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am. 1989;14:688–700.

    Article  PubMed  CAS  Google Scholar 

  4. Dellon AL. Techniques for successful management of ulnar nerve entrapment at the elbow. Neurosurg Clin N Am. 1991;2:57–73.

    PubMed  CAS  Google Scholar 

  5. Gay JR, Love JG. Diagnosis and treatment of tardy paralysis of the ulnar nerve; based on a study of 100 cases. J Bone Joint Surg Am. 1947;29:1087–1097.

    PubMed  CAS  Google Scholar 

  6. Hahn SB, Choi YR, Kang HJ. Corrective dome osteotomy for cubitus varus and valgus in adults. J Shoulder Elbow Surg. 2009;18:38–43.

    Article  PubMed  Google Scholar 

  7. Helfet DL, Kloen P, Anand N, Rosen HS. Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg Am. 2003;85:33–40.

    PubMed  Google Scholar 

  8. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  PubMed  CAS  Google Scholar 

  9. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br. 1975;57:430–436.

    PubMed  CAS  Google Scholar 

  10. Kim HT, Lee JS, Yoo CI. Management of cubitus varus and valgus. J Bone Joint Surg Am. 2005;87:771–780.

    Article  PubMed  Google Scholar 

  11. Masada K, Kawai H, Kawabata H, Masatomi T, Tsuyuguchi Y, Yamamoto K. Osteosynthesis for old, established non-union of the lateral condyle of the humerus. J Bone Joint Surg Am. 1990;72:32–40.

    PubMed  CAS  Google Scholar 

  12. Mc Gowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950;32:293–301.

    Google Scholar 

  13. Mortazavi SM, Heidari P, Asadollahi S, Farzan M. Severe tardy ulnar nerve palsy caused by traumatic cubitus valgus deformity: functional outcome of subcutaneous anterior transposition. J Hand Surg Eur Vol. 2008;33:575–580.

    Article  PubMed  Google Scholar 

  14. Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S. The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg. 2000;106:327–334.

    Article  PubMed  CAS  Google Scholar 

  15. Nouhan R, Kleinert JM. Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg Am. 1997;22:127–131.

    Article  PubMed  CAS  Google Scholar 

  16. Oppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res. 1984;188:34–39.

    PubMed  Google Scholar 

  17. Tien YC, Chen JC, Fu YC, Chih TT, Hunag PJ, Wang GJ. Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children. J Bone Joint Surg Am. 2005;87:1456–1463.

    Article  PubMed  Google Scholar 

  18. Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Harata S. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg Am. 2002;84:593–598.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Bo Ram Kim RN (specializing in orthopaedics), for assessing clinical outcomes and collecting data and Dong Soo Jang (medical illustrator), for the schematic drawings of operative procedure.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, South Korea

    Ho Jung Kang MD, Il Hyun Koh MD, Yu Chul Jeong MD, Tae Hwan Yoon MD & Yun Rak Choi MD

Authors
  1. Ho Jung Kang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Il Hyun Koh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu Chul Jeong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tae Hwan Yoon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yun Rak Choi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yun Rak Choi MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Kang, H.J., Koh, I.H., Jeong, Y.C. et al. Efficacy of Combined Osteotomy and Ulnar Nerve Transposition for Cubitus Valgus With Ulnar Nerve Palsy in Adults. Clin Orthop Relat Res 471, 3244–3250 (2013). https://doi.org/10.1007/s11999-013-3057-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3057-9

Keywords

Search

Navigation