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Related Concept Videos

Bones of the Upper Limb: Ulna01:15

Bones of the Upper Limb: Ulna

The ulna and radius are parallel bones of the antebrachium or the forearm. The ulna lies medially and consists of a bony tip called the olecranon process at its proximal end. This hook-like projection articulates with the olecranon fossa of the humerus and forms the "hinged" ulnohumeral part of the elbow joint. This joint facilitates forearm extension and flexion while preventing its hyperextension. Similarly, the coronoid process, another bony projection on the proximal/anterior side of the...

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Structured Motor Rehabilitation After Selective Nerve Transfers
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Routine Transposition or In Situ Decompression? Rethinking Ulnar Nerve Strategy in Distal Humerus Fractures.

Tahir Öztürk1, Mete Gedikbaş2, Fırat Erpala3

  • 1Department of Orthopaedics and Traumatology, Memorial Bahçelievler Hospital, 34180 İstanbul, Turkey.

Journal of Clinical Medicine
|October 29, 2025
PubMed
Summary

Anterior transposition of the ulnar nerve during distal humerus fracture surgery increases postoperative neuropathy risk. Surgeons should avoid routine transposition unless patients have pre-existing ulnar neuropathy, where it may aid recovery.

Keywords:
distal humerus fractureneuropathytranspositionulnar nerve

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Area of Science:

  • Orthopedic Surgery
  • Neurology
  • Trauma Care

Background:

  • Distal humerus fractures (DHFs) are complex intra-articular injuries.
  • Postoperative ulnar neuropathy is a common complication following DHF treatment.
  • Optimal ulnar nerve management during open reduction and internal fixation (ORIF) remains debated.

Purpose of the Study:

  • To compare the incidence of postoperative ulnar neuropathy (UN) after ORIF for DHFs.
  • To evaluate outcomes between anterior transposition (AT) and in situ decompression (ISD) of the ulnar nerve.
  • To assess the impact of AT on patients with preoperative UN.

Main Methods:

  • Retrospective review of 68 patients undergoing ORIF for intra-articular DHFs (2018-2022).
  • Patients were grouped into AT (n=14) and ISD (n=54).
  • Ulnar neuropathy assessed using the modified McGowan classification; radiographic outcomes by AO/OTA classification.

Main Results:

  • Postoperative UN incidence was 30.8% overall.
  • Higher UN rates observed in the AT group (57.1%) versus ISD group (24%) (p=0.012).
  • AT showed better functional recovery in patients with preoperative UN (71% resolution vs. 60% in ISD).

Conclusions:

  • Routine AT for ulnar nerve management in DHF ORIF increases postoperative neuropathy risk and should be avoided in asymptomatic patients.
  • AT may be beneficial for patients with preoperative ulnar neuropathy.
  • Individualized ulnar nerve management is crucial to balance surgical risks and neurological outcomes.