Tardy Ulnar Nerve Palsy due to Cubitus Varus Deformity Jeon, In-Ho; Kim, Poong-Taek; Park, Byung-Chul; Ihn, Joo-Chul;
Purpose : Cubitus varus deformity has been reported to cause ulnar neuropathy. We present five cases of tardy ulnar nerve palsy due to cubitus vus and analyzed the factors related to the nerve plasy caused by the deformity. Materials and Methods : Three men and two women were reviewed retrospectively and the mean age of the patients were 26 (range, 14-38). The average interval from initial fracture to nerve palsy was 19 years (8-32 years). The severity of symptoms, according to McGowan's classification, was grade I of 2 patients, grade Ⅱ of 3 patients. Carrying angle was an average of 18。 (30° -45° ). Internal rotation angle measured by Yamamoto's method was an average of 33° (30° -45° ). Results ㆍ The mean follow-up period was 53 months (35-70 months). Elbow pain and numbness of the fingers were relieved shortly after surgery. It revealed that anterior subluxation of the nerve due to internal rotation deformity and compression of the nerve between the medially shifted medial head of triceps and the medial epicondyle. Conclusion : The major entrapment point of the nerve is the fibrous band between the two heads of the flexor carpi ulnaris. The severe internal rotation deformity may contribute the cause of tardy ulnar nerve palsy in cubitus varus deformity.
Abe M, Ishizu T, Shirai H et al : Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg, 20A:5-9, 1995.
Dreyfuss U and Kessler E : Snapping elbow due to dislocation of the medial head of the triceps. J Bone Joint Surg, 60B:56-57, 1978.
Fujioka H, Nakabayashi Y, Hirata S et al : Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after a supracondylar fractures of the humerus: A report of four cases. J Orthopedic Trauma, 9:435-440, 1995.
Hayashi Y, Kojima T and Kohno T : A case of cubital tunnel syndrome caused by the snapping of the medial head of the triceps brachii muscle. J hand Surg, 9A:96-99, 1984.
McGowan AJ : The results of transposition of the ulnar nerve for traumatic neuritis. J Bone Joint Surg, 32B:293-301, 1950.
Minami A and Sugawara M : Humeral trochlear hypoplasia secondary to epiphyseal injury as a cause of ulnar nerve palsy. Clin Orthop, 228 :227-232, 1988.
Mitsunari A, Muneshige H, Ikuda Y et al : Intern a l rotation deformity and tardy ulnar nerve palsy after supracondylar humeral fracture. J Shoulder Elbow Surg, 4:23-29, 1995.
Ogino T, Minami A and Fukuda K : Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg, 11B:352-356, 1986.
Spinner RJ, O'Driscoll SW, Davids JR et al : Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve. J Hand Surg, 24A:718-726, 1999
Spinner RJ and Goldner RD : Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. J Bone Joint Surg, 80A :239-247, 1998.
Uchida Y and Sugioka Y : Ulnar nerve palsy after supracondylar humerus fracture. Acta Orthop Scand, 61:118-119, 1990.
Usui M, Ishii S, Miyano S et al : Three-dimensional corrective osteotomy for treatment of cubitus varus after supracondylar fracture of the humerus in children. J Shoulder Elbow Surg, 4: 17-22, 1995.
Yamamoto I, Ishii S, Usui M, et al : Cubitus varus deformity following supracondylar fracture of the humerus. Clin Orthop, 201:179-185, 1985.