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Clin Shoulder Elbow > Volume 20(4); 2017 > Article
Clinics in Shoulder and Elbow 2017;20(4):236-239.
DOI:    Published online December 31, 2017.
Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures
Jae Hyuk Shin, Whan Jin Kwon, Yoon Suk Hyun
Department of Orthopaedic Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
Received: 30 September 2017   • Revised: 6 November 2017   • Accepted: 13 November 2017
After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.
Key Words: AO type C; Distal humerus fractures; Ulnar nerve; Internal fixation
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