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

Authors
 Ho Jung Kang  ;  Il Hyun Koh  ;  Yu Chul Jeong  ;  Tae Hwan Yoon  ;  Yun Rak Choi 
Citation
 CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol.471(10) : 3244-3250, 2013 
Journal Title
 CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 
ISSN
 0009-921X 
Issue Date
2013
MeSH
Adult ; Elbow Joint/diagnostic imaging ; Elbow Joint/physiopathology ; Elbow Joint/surgery* ; Female ; Humans ; Humerus/diagnostic imaging ; Humerus/physiopathology ; Humerus/surgery ; Joint Deformities, Acquired/complications ; Joint Deformities, Acquired/physiopathology ; Joint Deformities, Acquired/surgery* ; Male ; Middle Aged ; Osteotomy/methods* ; Radiography ; Range of Motion, Articular/physiology ; Retrospective Studies ; Treatment Outcome ; Ulna/diagnostic imaging ; Ulna/physiopathology ; Ulna/surgery ; Ulnar Nerve/diagnostic imaging ; Ulnar Nerve/physiopathology ; Ulnar Nerve/surgery* ; Ulnar Neuropathies/etiology ; Ulnar Neuropathies/physiopathology ; Ulnar Neuropathies/surgery*
Keywords
Grip Strength ; Ulnar Nerve ; Lateral Condyle ; Distal Humerus ; Locking Compression Plate
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.
Full Text
http://link.springer.com/article/10.1007%2Fs11999-013-3057-9
DOI
10.1007/s11999-013-3057-9
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ho Jung(강호정) ORCID logo https://orcid.org/0000-0003-0273-1264
Koh, Il Hyun(고일현) ORCID logo https://orcid.org/0000-0001-9823-8516
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Choi, Yun Rak(최윤락)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87690
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