Akademik Veri Yönetim Sistemi
JOURNAL OF CLINICAL MEDICINE, cilt.14, sa.20, ss.1-11, 2025 (SCI-Expanded, Scopus)
Background: Fractures of the distal humerus (DHFs) represent challenging intra-articular
injuries that are often followed by postoperative complications, most notably ulnar neu-
ropathy. There is still debate regarding the best method of handling the ulnar nerve during
open reduction and internal fixation (ORIF). Objective: The primary objective was to
evaluate the incidence of postoperative ulnar neuropathy (UN) in patients who underwent
open reduction and internal fixation (ORIF) for DHFs, comparing anterior transposition
(AT) with in situ decompression (ISD) of the ulnar nerve. Additionally, we investigated the
influence of AT on individuals presenting with preoperative UN. Methods: A retrospective
review was conducted on 68 patients (26 females and 42 males; mean age: 46.3 years) who
underwent ORIF for intra-articular DHF between 2018 and 2022. Patients were divided
into two groups: anterior transposition (n = 14) and in situ decompression (n = 54). Ulnar
neuropathy was evaluated using the modified McGowan classification, and radiographic
outcomes were assessed with AO/OTA fracture classification. Results: Sixty-eight pa-
tients (26F/42M) were included. The mean age was 46.3 years (20–77 years) and the mean
follow-up time was 53 months (36–76 months). The postoperative UN incidence was 30.8%
(21/68). Neuropathy was significantly higher in the transposition group compared to in
situ decompression (57.1% vs. 24%; p = 0.012). Olecranon osteotomy (36.3% vs. 20%;
p = 0.042) and parallel plate configuration (33.3% vs. 12.5%; p = 0.037) were also associated
with increased neuropathy risk. Among patients with preoperative ulnar neuropathy
(n = 12), functional recovery was more favorable with transposition, where 71% experi-
enced full resolution compared to 60% in the in situ group. Conclusions: Routine anterior
transposition of the ulnar nerve during ORIF for DHF is associated with an increased
risk of postoperative neuropathy and should be avoided in patients without preoperative
symptoms. However, transposition appears beneficial in patients with pre-existing ulnar
neuropathy. Surgeons should individualize ulnar nerve management to balance surgical
risks and neurological outcomes.