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

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.