Current concepts review - The ulnar nerve in elbow trauma

The prevalence of ulnar nerve dysfunction after elbow injury is unknown because authors of published investigations have inadequately differentiated among acute injury-related, acute surgery-related, and delayed (subacute or chronic) ulnar neuropathies and these retrospective case series have not included careful evaluation of ulnar nerve function. Ulnar neuropathy is well documented after distal humeral fracture, but it can also develop following any complex elbow trauma. The ulnar nerve should be identified and protected during the treatment of a bicolumnar fracture of the distal part of the humerus, but current data are inconclusive regarding the value of routine anterior transposition of the nerve. Although most delayed ulnar neuropathies present at a relatively late stage with weakness, with or without muscle atrophy, improved motor strength may be observed in some patients many years after ulnar nerve decompression. Ulnar nerve decompression and transposition are becoming an integral part of many posttraumatic reconstructive elbow procedures, but most recommendations for management of the ulnar nerve are based on retrospective reviews, anecdotal reports, and expert opinion.