Management of the ulnar nerve using an adipofascial flap in elbow surgery

Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and performing neurolysis are often the initial steps, even in the absence of clear symptoms. In this study, we assessed the clinical applicability of using an adipofascial flap to cover the nerve during elbow surgery.

A retrospective study of 53 patients with elbow conditions who underwent surgery between December 2020 and December 2023 was performed. All patients received an X-ray of the elbow and electromyography (ENMG). The following scores were recorded: NRS, MEPS, and McGowan, both preoperatively and at the 1-year follow-up.

The NRS score decreased from 7.9 ± 0.8 (range: 6-9) to 2.8 ± 1.3 (range: 0-7) at the 1-year follow-up. MEPS improved from 70.7 ± 15.9 (range: 20-100) to 96.5 ± 7.2 (range: 70-100), indicating reduced pain and improved elbow function. The McGowan scale showed improvements in 49 out of 53 cases. All patients, except one, were satisfied with the surgery, and no recurrence of ulnar nerve-related pain was observed.

Preliminary results suggest that covering the ulnar nerve with an adipofascial flap following neurolysis and/or anterior transposition is an effective method for managing ulnar nerve entrapment. It appears to help prevent post-surgical complications and adhesions, which are the main causes of the high recurrence rates reported in the literature.