Autogenous Vein Wrapping versus In Situ Decompression for Management of Secondary Cubital Tunnel Syndrome after Surgical Fixation of Elbow Fractures: Short-Term Functional and Neurophysiological Outcome

Abstract

Purpose The aim of this study was to compare the functional and neurophysiological outcome of in situ decompression versus in situ decompression augmented with autogenous vein wrapping in management of secondary cubital tunnel syndrome at the elbow following fixation of elbow fractures.

Methods A prospective comparative randomized study was performed on 29 patients who were divided into two groups: group I (in situ decompression) and group II (in situ decompression augmented with autogenous vein wrapping). We measured the patients' demographics, subjective reports of symptoms, and objective evaluation of the functional and neurophysiological outcomes of both groups.

Results Group II patients achieved statistically better results in both neurophysiological scoring and clinical sensory rating but not in all other parameters.

Conclusion Autogenous vein wrapping for secondary cubital tunnel syndrome after elbow fracture fixation only provides a better sensory outcome.

Level of Evidence Level II, therapeutic prospective comparative study.

Keywords

vein wrapping - in situ decompression - secondary cubital tunnel syndrome - elbow fractures

• References

• 1 Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. (Review) Cochrane Database Syst Rev 2012; 7 (7) CD006839
• 2 Naran S, Imbriglia JE, Bilonick RA, Taieb A, Wollstein R. A demographic analysis of cubital tunnel syndrome. Ann Plast Surg 2010; 64 (2) 177-179
• 3 Assmus H, Antoniadis G, Bischoff C , et al. Cubital tunnel syndrome - a review and management guidelines. Cent Eur Neurosurg 2011; 72 (2) 90-98
• 4 Chimenti PC, Hammert WC. Ulnar neuropathy at the elbow: an evidence-based algorithm. Hand Clin 2013; 29 (3) 435-442
• 5 Vardakas DG, Varitimidis SE, Sotereanos DG. Findings of exploration of a vein-wrapped ulnar nerve: report of a case. J Hand Surg Am 2001; 26 (1) 60-63
• 6 Kokkalis ZT, Jain S, Sotereanos DG. Vein wrapping at cubital tunnel for ulnar nerve problems. J Shoulder Elbow Surg 2010; 19 (2, Suppl): 91-97
• 7 Gabel GT, Amadio PC. Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg Am 1990; 72 (2) 213-219
• 8 Padua L, Aprile I, Mazza O , et al. Neurophysiological classification of ulnar entrapment across the elbow. Neurol Sci 2001; 22 (1) 11-16
• 9 Xu J, Varitimidis SE, Fisher KJ, Tomaino MM, Sotereanos DG. The effect of wrapping scarred nerves with autogenous vein graft to treat recurrent chronic nerve compression. J Hand Surg Am 2000; 25 (1) 93-103
• 10 Preston DC, Shapeiro BE. Routine upper extremity and facial nerve conduction techniques. In: Preston DC, Shapeiro BE, eds. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations. 2nd ed. Philadelphia, PA: Elsevier; 2005: 117-143
• 11 Kincaid JC, Phillips II LH, Daube JR. The evaluation of suspected ulnar neuropathy at the elbow. Normal conduction study values. Arch Neurol 1986; 43 (1) 44-47
• 12 Novak CB, Mackinnon SE. Selection of operative procedures for cubital tunnel syndrome. Hand (NY) 2009; 4 (1) 50-54
• 13 Vazquez O, Rutgers M, Ring DC, Walsh M, Egol KA. Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma 2010; 24 (7) 395-399
• 14 Adkinson JM, Chung KC. Minimal-incision in situ ulnar nerve decompression at the elbow. Hand Clin 2014; 30 (1) 63-70
• 15 Bolster MA, Zöphel OT, van den Heuvel ER, Ruettermann M. Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique. J Hand Surg Eur Vol 2014; 39 (6) 621-625
• 16 Ochi K, Horiuchi Y, Nakamura T, Sato K, Arino H, Koyanagi T. Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome: effect of simple decompression. J Hand Surg Eur Vol 2013; 38 (5) 474-480
• 17 Kamat AS, Jay SM, Benoiton LA, Correia JA, Woon K. Comparative outcomes of ulnar nerve transposition versus neurolysis in patients with entrapment neuropathy at the cubital tunnel: a 20-year analysis. Acta Neurochir (Wien) 2014; 156 (1) 153-157
• 18 Puckett BN, Gaston RG, Lourie GM. A novel technique for the treatment of recurrent cubital tunnel syndrome: ulnar nerve wrapping with a tissue engineered bioscaffold. J Hand Surg Eur Vol 2011; 36 (2) 130-134
• 19 Soltani AM, Allan BJ, Best MJ, Mir HS, Panthaki ZJ. Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. Ann Plast Surg 2014; 72 (5) 572-578
• 20 Lavasani M, Gehrmann S, Gharaibeh B , et al. Venous graft-derived cells participate in peripheral nerve regeneration. PLoS ONE 2011; 6 (9) e24801
• 21 Greene JW, Ozyurekoglu T. Posterior elbow capsular contracture and ulnar nerve entrapment after olecranon excision and triceps tendon advancement. Inj Extra 2010; 41 (7) 71-73
• 22 Hoffmann R, Lubahn J. Endoscopic cubital tunnel release using the Hoffmann technique. J Hand Surg Am 2013; 38 (6) 1234-1239