Humeral Fractures, Ulnar Nerve Compression
Conditions
Keywords
distal humerus, fractures, ulnar nerve, simple decompression, anterior transposition
Brief summary
Both simple decompression and anterior transposition of the elbow nerve (ulnar nerve) for acute displaced fractures of the elbow (distal humerus) treated with plate fixation are currently used by surgeons. We want to examine which treatment will overall give better results in regards to arm function and residual pain.
Interventions
PROCEDURESimple decompression
Fracture fixation will be performed through a posterior approach, as this provides excellent visualization of the distal fragments. A triceps split will be used to expose the distal humerus. A midline incision will be made from proximally to distal onto the shaft of the ulna. Equal portions of the triceps muscle will be reflected medially and laterally, with use of sharp dissection to remove the triceps insertion from the olecranon. The ulnar nerve will be identified and protected proximal and distal to the medial epicondyle. Fracture fixation will be performed after anatomic reduction using standard fixation techniques and plate fixation on both the medial and lateral column. In the simple ulnar nerve decompression group, no further treatment of the ulnar nerve will be undertaken.
PROCEDUREanterior subcutaneous transposition
In the anterior transposition of the ulnar nerve group, the ulnar nerve will be placed subcutaneously anterior to the medial epicondyle free from any pressure.
Sponsors
Unity Health Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Men or women aged 16 to 60 years of age * Displaced, distal humerus fracture (OTA 13A or 13C) as seen in radiographs * Fractures ≤ 28 days post injury * Closed fractures * No history of previous ulnar neuropathy or elbow pathology * Provisin of informed consent
Exclusion criteria
* Vascular injury * History of previous ulnar neuropathy or elbow pathology * Fractures more than 28 days post-injury * Limited life expectancy due to significant medical co-morbidity or medical contraindication to surgery * Inability to comply with rehabilitation or form completion * Likely problems, in the judgement of the investigators, with maintaining follow-up (i.e. patients with no fixed address, patients not mentally competent to give consent, etc.)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome will be signs of ulnar neuropathy, measured using two clinical staging systems to assess the degree of dysfunction of the ulnar nerve (the classification system of Gabel and Amadio13). | 1 Year |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcome measurement will include a patient-oriented, limb-specific, functional measurement questionnaire (Disabilities of the Arm, Shoulder and Hand Instrument-DASH) | 1 Year |
Countries
Canada
Outcome results
None listed