1. 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.