OBJECTIVE: To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome. METHODS: From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed. RESULTS: All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied. CONCLUSION The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Cubital Tunnel Syndrome/surgery* ; Ulnar Nerve/surgery* ; Neurosurgical Procedures/methods* ; Decompression, Surgical/methods* ; Prognosis

OBJECTIVE: To explore feasibility of protecting ulnar nerve by ultrasound in treating children with supracondylar fracture of humerus by closed reduction and intercross needle fixation. METHODS: From January 2018 to December 2019, 63 children with supracondylar fractures of humerus were divided into two groups(ultrasound group and X-ray group) depend on the different ways of guidance. Therer were 32 children in ultrasound group treated with closed reduction and Kirschner wire fixation guided by ultrasound, including 20 males and 12 females, aged from 3 to 11 years old with an average of (6.06±2.02) years old. There were 31 children in X-ray group treated with closed reduction and Kirschner wire fixation guided by X-ray, including 17 males and 14 females, aged from 2 to 10 years old with an average of (5.61±1.96) years old. Operation time, X-ray times, fracture healing time, ulnar nerve injury and postoperaqtive Flynn clinical function assessment at 1 year between two groups were recorded and compared. RESULTS: All patients were followed up. The follow-up time of ultrasound group ranged from 9 to 12 months with an average of (11.53±0.76) months, and X-ray group ranged from 10 to 13 months with an average of (11.51±0.72) months. There was no significant difference in operation time, follow-up time and fracture healing time between two groups(P>0.05). The number of intraoperative electrodialysis in ultrasound group was (3.06±1.24) times, and that in X-ray group was (21.65±5.58) times, which was significantly higher than that in ultrasound group(P<0.01). No iatrogenic ulnar nerve injury occurred in ultrasound group, and 2 cases of ulnar nerve injury occurred in X-ray group, the incidence of ulnar nerve injury in ultrasound group was lower than that in X-ray group, but the difference was not statistically significant(P>0.05). At 1 year after operation, Flynn clinical function assessment results in ultrasound group was excellent in 27 cases, 4 cases good and 1 case fair, in X-ray group 23 cases got excellent result, 6 cases good, 1 fair and 1 poor, there was no significant difference between two groups(P>0.05 ). CONCLUSION Ultrasound guided and X-ray guided treatment of supracondylar fractures of humerus in children have similar effect of opertaion time and fracture healing, while ultrasound guidance could clearly detected the position of ulnar nerve, and avoid occurrence of iatrogenic ulnar nerve injury caused by ulnar puncture, which is a safe and effective treatment method.
Child ; Child, Preschool ; Feasibility Studies ; Female ; Fracture Fixation, Internal/methods* ; Humans ; Humeral Fractures/surgery* ; Humerus/surgery* ; Male ; Ulnar Nerve

INTRODUCTION: The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion. METHODS: The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed. RESULTS: A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection. CONCLUSION This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.
Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fluoroscopy ; Fracture Fixation, Intramedullary ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; Iatrogenic Disease ; Male ; Pediatrics ; Radiography ; Retrospective Studies ; Ulnar Nerve

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
Adult ; Cubital Tunnel Syndrome/*diagnosis/physiopathology/*surgery ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Hand/surgery ; Hand Strength ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/*methods ; Prospective Studies ; Recovery of Function ; Surveys and Questionnaires ; Treatment Outcome ; Ulnar Nerve/physiopathology/*surgery ; Young Adult

Forearm ; innervation ; Ganglion Cysts ; surgery ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; innervation ; surgery ; Tendons ; surgery ; Ulnar Nerve ; surgery

Accessory Nerve ; transplantation ; Birth Injuries ; complications ; surgery ; Brachial Plexus Neuropathies ; etiology ; surgery ; Child, Preschool ; Early Medical Intervention ; Elbow ; Humans ; Infant ; Intercostal Nerves ; transplantation ; Nerve Transfer ; methods ; Radial Nerve ; surgery ; Sural Nerve ; transplantation ; Time Factors ; Treatment Outcome ; Ulnar Nerve ; transplantation

Female ; Humans ; Manipulation, Orthopedic ; Middle Aged ; Radius Fractures ; surgery ; Ulna Fractures ; surgery ; Ulnar Nerve Compression Syndromes ; surgery

OBJECTIVETo explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side.

METHODSFrom April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps. Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomosed with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg.

RESULTSAll the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.

CONCLUSIONSFree medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.

Adult ; Female ; Foot ; surgery ; Free Tissue Flaps ; Hand Injuries ; surgery ; Humans ; Male ; Skin ; injuries ; Ulnar Nerve ; injuries ; surgery ; Wrist Injuries ; surgery ; Young Adult

Elbow Joint ; innervation ; surgery ; Humans ; Male ; Median Nerve ; abnormalities ; Ulnar Nerve ; abnormalities ; Young Adult

Adult ; Aged ; Elbow ; innervation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nerve Compression Syndromes ; physiopathology ; surgery ; Recovery of Function ; Ulnar Nerve ; physiopathology ; surgery