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Is routine ulnar nerve transposition necessary in open release of stiff elbows? Our experience and a literature review

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Abstract

Purpose

Prophylactic release of the ulnar nerve to reduce the incidence of postoperative nerve symptoms in stiff elbows has been recommended. However, the necessity for routine anterior transposition remains unclear. In this study, we aim to gain an insight into the value of routine transposition in open release of stiff elbows.

Methods

We retrospectively reviewed 94 patients suffering from elbow stiffness with no pre-operative ulnar nerve symptoms. Simple decompression (with in situ decompression or epicondylectomy) and subcutaneous anterior transposition were chronologically performed in 53 and 37 patients, respectively. Another four patients were treated by a single lateral approach with no intervention of the ulnar nerve. Pre- and postoperative range of motion and incidence of ulnar nerve symptoms were recorded. The function of ulnar nerve was measured by Amadio rating scale.

Results

The incidence of ulnar nerve dysfuction was 18.9 % (ten of 53) and 8.1 % (three of 37) in the simple decompression and transposition groups, respectively. The mean Amadio scores were 7.62 and 8.22, respectively. All these data showed a statistically significant difference (P < 0.05). In the lateral approach group, 50 % (two of four) of patients developed nerve symptoms with a mean Amadio score of 6.50.

Conclusions

The transposition group exhibited a superior nervous outcomes compared with the simple decompression group. No comparison was conducted between the transposition and lateral approach groups because of too few patients in the latter. According to related literature and our experience, we conclude that routine transposition is necessary to prevent postoperative nerve symptoms.

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References

  1. Aldridge JM, Atkins TA, Gunneson EE, Urbaniak JR (2004) Anterior release of the elbow for extension loss. J Bone Joint Surg Am 86A(9):1955–1960

    Google Scholar 

  2. Williams BG, Sotereanos DG, Baratz ME, Jarrett CD, Venouziou AI, Miller MC (2012) The contracted elbow: is ulnar nerve release necessary? J Should Elb Surg 21 (12):1632-1636. doi: 10.1016/J.Jse.2012.04.007

  3. Liu S, Fan CY, Ruan HJ, Li FF, Tian J (2011) Combination of arthrolysis by lateral and medial approaches and hinged external fixation in the treatment of stiff elbow. J Trauma 70(2):373–376. doi:10.1097/TA.0b013e3181e4f5e3

    Article  PubMed  Google Scholar 

  4. Rhee YG, Cho NS, Lim CT, Yi JW (2009) Debridement arthroplasty for post-traumatic stiff elbow: intraoperative factors affecting the clinical results of surgical treatment. Clin Orthop Surg 1(1):27–33. doi:10.4055/cios.2009.1.1.27

    Article  PubMed  PubMed Central  Google Scholar 

  5. Darlis NA, Kaufmann RW, Sotereanos DG (2006) Open surgical treatment of post-traumatic elbow contractures in adolescent patients. J Should Elb Surg 15(6):709–715. doi:10.1016/j.jse.2006.01.006

    Article  Google Scholar 

  6. Brinsden MD, Carr AJ, Rees JL (2008) Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach. J Orthop Surg Res 3:39–39. doi:10.1186/1749-799x-3-39

    Article  PubMed  PubMed Central  Google Scholar 

  7. Urbaniak JR, Hansen PE, Beissinger SF, Aitken MS (1985) Correction of post-traumatic flexion contracture of the elbow by anterior capsulotomy. J Bone Joint Surg Am 67(8)

  8. Gates H, Sullivan F, Urbaniak J (1992) Anterior capsulotomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow. J Bone Joint Surg 74(8):1229–1234

    PubMed  Google Scholar 

  9. Wilson PD (2000) Capsulectomy for the relief of flexion contractures of the elbow following fracture (Reprinted from J Bone Joint Surg 26:71–86, 1944). Clin Orthop Relat Res 370:3–8

    Article  PubMed  Google Scholar 

  10. Antuna SA, Morrey BF, Adams RA, O'Driscoll SW (2002) Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow. Long-term outcome and complications. J Bone Joint Surg Am 84A(12):2168–2173

    Google Scholar 

  11. Breborowicz M, Lubiatowski P, Dlugosz J, Ogrodowicz P, Wojtaszek M, Lisiewicz E, Zygmunt A, Romanowski L (2014) The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases. Int Orthop 38(3):561–567. doi:10.1007/s00264-013-2172-2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cohen M, Hastings H (1998) Post-traumatic contracture of the elbow Operative release using a lateral collateral ligament sparing approach. J Bone Joint Surg Br 80(5):805–812

    Article  PubMed  CAS  Google Scholar 

  13. Ouyang Y, Wang Y, Li F, Fan C (2012) Open release and a hinged external fixator for the treatment of elbow stiffness in young patients. Orthopedics 35(9):e1365–e1370. doi:10.3928/01477447-20120822-23

    Article  PubMed  Google Scholar 

  14. Park MJ, Chang MJ, Lee YB, Kang HJ (2011) Surgical release for posttraumatic loss of elbow flexion. The Journal of Bone & Joint Surgery Essential Surgical Techniques 1(e16):11–18

  15. Gundlach U, Eygendaal D (2008) Surgical treatment of posttraumatic stiffness of the elbow: 2-year outcome in 21 patients after a column procedure. Acta Orthop 79(1):74–77

    Article  PubMed  Google Scholar 

  16. Lindenhovius ALC, Doornberg JN, Ring D, Jupiter JB (2010) Health Status After Open Elbow Contracture Release. J Bone Joint Surg Am 92A(12):2187–2195. doi:10.2106/jbjs.h.01594

    Article  Google Scholar 

  17. Ruan HJ, Liu S, Fan CY, Liu JJ (2013) Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg 133(2):179–185. doi:10.1007/s00402-012-1659-4

    Article  PubMed  Google Scholar 

  18. Morrey B (1992) Primary degenerative arthritis of the elbow. Treatment by ulnohumeral arthroplasty. J Bone Joint Surg Br Vol 74(3):409–413

    CAS  Google Scholar 

  19. Apfelberg DB, Larson SJ (1973) Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 51(1):79–81

    PubMed  CAS  Google Scholar 

  20. Schuind FA, Goldschmidt D, Bastin C, Burny F (1995) A biomechanical study of the ulnar nerve at the elbow. J Hand Surg (Br) 20(5):623–627. doi:10.1016/s0266-7681(05)80124-x

    Article  CAS  Google Scholar 

  21. Huang JH, Samadani U, Zager EL (2004) Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery 55(5):1150–1153

    Article  PubMed  Google Scholar 

  22. Koh KH, Lim TK, Lee HI, Park MJ (2013) Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Shoulder Elb Surg 22(8):1128–1134

    Article  Google Scholar 

  23. Black BT, Barron OA, Townsend PF, Glickel SZ, Eaton RG (2000) Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up. J Bone Joint Surg 82(11):1544–1544

    PubMed  Google Scholar 

  24. Lascar T, Laulan J (2000) Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg (Br) 25(5):453–456

    Article  CAS  Google Scholar 

  25. Patterson SD, Bain GI, Mehta JA (2000) Surgical approaches to the elbow. Clin Orthop Relat Res 370:19–33

    Article  PubMed  Google Scholar 

  26. Ducic I, Felder JM III, Quadri HS (2012) Common nerve decompressions of the upper extremity: reliable exposure using shorter incisions. Ann Plast Surg 68(6):606–609

    Article  PubMed  CAS  Google Scholar 

  27. Amadio PC (1986) Anatomical basis for a technique of ulnar nerve transposition. Surg Radiol Anat 8(3):155–161

    Article  PubMed  CAS  Google Scholar 

  28. Brauer C, Graham B (2007) The surgical treatment of cubital tunnel syndrome: a decision analysis. J Hand Surg (Br) 32(6):654–662

    Article  CAS  Google Scholar 

  29. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA (2008) Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 33(8):1314, e1–2. doi:10.1016/j.jhsa.2008.03.006

  30. Macnicol MF (1979) The results of operation for ulnar neuritis. J Bone Joint Surg (Br) 61-B(2):159–164

    CAS  Google Scholar 

  31. Kleinman WB (1999) Cubital tunnel syndrome: Anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am] 24A(5):886–897

    Article  Google Scholar 

  32. Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP, Bindra RR, Hsieh P, Silva MJ (1998) Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow—An experimental study in human cadavera. J Bone Joint Surg Am 80A(4):492–501

    Google Scholar 

  33. Ogata K, Manske PR, Lesker PA (1985) The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel. Clin Orthop Relat Res 193:195–198

    PubMed  Google Scholar 

  34. Gabel GT, Amadio PC (1990) Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg Am 72(2):213–219

    PubMed  CAS  Google Scholar 

  35. Shin R, Ring D (2007) Current concepts review—The ulnar nerve in elbow trauma. J Bone Joint Surg Am 89A(5):1108–1116. doi:10.2106/jbjs.f.00594

    Article  Google Scholar 

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Acknowledgment

The authors thank Shichao Jiang and Wei Wang for their assistance and helpful suggestions for this work.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chen Shuai, Liu Shen, Ouyang Yuanming, Ruan Hongjiang & Fan Cunyi

  2. Division of Plastic and Hand Surgery, Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Yan Hede

Authors
  1. Chen Shuai
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  2. Yan Hede
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  3. Liu Shen
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  4. Ouyang Yuanming
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  5. Ruan Hongjiang
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  6. Fan Cunyi
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Corresponding authors

Correspondence to Ruan Hongjiang or Fan Cunyi.

Additional information

Yan Hede contributed equally to this article as co-first author.

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Shuai, C., Hede, Y., Shen, L. et al. Is routine ulnar nerve transposition necessary in open release of stiff elbows? Our experience and a literature review. International Orthopaedics (SICOT) 38, 2289–2294 (2014). https://doi.org/10.1007/s00264-014-2465-0

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  • DOI: https://doi.org/10.1007/s00264-014-2465-0

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