University of Modena and Reggio Emilia (ITALY) Department of Pathology of Locomotor Apparatus Orthopaedic and Traumatologic Clinic chief. Prof. F.Catani Therapeutic and preventive anteposition of the ulnar nerve at the elbow C.Rovesta, M.C.Marongiu, A.Corradini, G.Paltrinieri, F.Catani After in situ decompression of the Ulnar nerve we can perform ANTEPOSITION Subcutaneus (Intramuscular) Anterior to medial epicondyle 1 WHEN WE HAVE Possibility of groove adherence Possible compression from syntesis Possible compression by bony callus Recurrence of compression Nerve dislocation during flexion/extension Extreme nerve stretching during movement Irregularity groove Cubitus valgus THERAPEUTIC ANTEPOSITION PREVENTIVE ANTEPOSITION 55 patients with Ulnar nerve decompression followed by ANTEPOSITION from 2007 to 2009 23 Therapeutic 12 male, 11 female; mean age 46 ys. and 11 m 11 ulnar neuropathy alone (2 recurrences), 12 ulnar neuropathy after elbow fracture Evaluated with McGowan, MEPS, BISHOP, Emg 32 Preventive 15 male, 17 female; mean age 49 ys. and 4 m 11 ORIF (C2/C3 AO), 17 prosthesis, 4 arthroplasty 6 with pre-surgery partial deficit of Ulnar n. 78 % complete sensitive and motor recovery In 13 patients well-tolerated simptoms of ulnar deficit DISADVANTAGE OF ANTEPOSITION Peri-neural devascularization Risk of neural kinking Superficial position can determine pain during direct pressure IT NEEDS A CORRECT SURGICAL TECHNIQUE CONCLUSION Subcutaneous anteposition is good for symptomatic ulnar nerve compression at the elbow but also to prevent compression and to do an early, wide and safe movement in distal humeral fracture treated with ORIF or prosthesis.