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Simple Decompression Versus Anterior Transposition of the Ulnar Nerve

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
St. Michael's Hospital, Toronto Identifier:
First received: January 18, 2010
Last updated: October 24, 2016
Last verified: October 2016
Both simple decompression and anterior transposition of the elbow nerve (ulnar nerve) for acute displaced fractures of the elbow (distal humerus) treated with plate fixation are currently used by surgeons. We want to examine which treatment will overall give better results in regards to arm function and residual pain.

Condition Intervention
Humeral Fractures Ulnar Nerve Compression Procedure: Simple decompression Procedure: anterior subcutaneous transposition

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multicentre, Randomized Trial of Simple Decompression Versus Anterior Transposition of the Ulnar Nerve for Acute, Displaced Fractures of the Distal Humerus Treated With Plate Fixation

Resource links provided by NLM:

Further study details as provided by St. Michael's Hospital, Toronto:

Primary Outcome Measures:
  • The primary outcome will be signs of ulnar neuropathy, measured using two clinical staging systems to assess the degree of dysfunction of the ulnar nerve (the classification system of Gabel and Amadio13). [ Time Frame: 1 Year ]

Secondary Outcome Measures:
  • Secondary outcome measurement will include a patient-oriented, limb-specific, functional measurement questionnaire (Disabilities of the Arm, Shoulder and Hand Instrument-DASH) [ Time Frame: 1 Year ]

Enrollment: 56
Study Start Date: September 2010
Estimated Study Completion Date: October 2017
Estimated Primary Completion Date: October 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: simple decompression Procedure: Simple decompression

Fracture fixation will be performed through a posterior approach, as this provides excellent visualization of the distal fragments. A triceps split will be used to expose the distal humerus. A midline incision will be made from proximally to distal onto the shaft of the ulna. Equal portions of the triceps muscle will be reflected medially and laterally, with use of sharp dissection to remove the triceps insertion from the olecranon. The ulnar nerve will be identified and protected proximal and distal to the medial epicondyle. Fracture fixation will be performed after anatomic reduction using standard fixation techniques and plate fixation on both the medial and lateral column.

In the simple ulnar nerve decompression group, no further treatment of the ulnar nerve will be undertaken.

Active Comparator: anterior subcutaneous transposition Procedure: anterior subcutaneous transposition
In the anterior transposition of the ulnar nerve group, the ulnar nerve will be placed subcutaneously anterior to the medial epicondyle free from any pressure.


Ages Eligible for Study:   16 Years to 60 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Men or women aged 16 to 60 years of age
  • Displaced, distal humerus fracture (OTA 13A or 13C) as seen in radiographs
  • Fractures ≤ 28 days post injury
  • Closed fractures
  • No history of previous ulnar neuropathy or elbow pathology
  • Provisin of informed consent

Exclusion Criteria:

  • Vascular injury
  • History of previous ulnar neuropathy or elbow pathology
  • Fractures more than 28 days post-injury
  • Limited life expectancy due to significant medical co-morbidity or medical contraindication to surgery
  • Inability to comply with rehabilitation or form completion
  • Likely problems, in the judgement of the investigators, with maintaining follow-up (i.e. patients with no fixed address, patients not mentally competent to give consent, etc.)
  Contacts and Locations
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Please refer to this study by its identifier: NCT01051869

Canada, Ontario
St. Michael's Hospital
Toronto, Ontario, Canada, M5C 1R6
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Principal Investigator: Emil H Schemitsch, MD, FRCS(C) St. Michael's Hospital, Toronto
  More Information

Responsible Party: St. Michael's Hospital, Toronto Identifier: NCT01051869     History of Changes
Other Study ID Numbers: Ulnar Nerve 06-Jan-10
Study First Received: January 18, 2010
Last Updated: October 24, 2016

Keywords provided by St. Michael's Hospital, Toronto:
distal humerus
ulnar nerve
simple decompression
anterior transposition

Additional relevant MeSH terms:
Ulnar Nerve Compression Syndromes
Nerve Compression Syndromes
Fractures, Bone
Humeral Fractures
Wounds and Injuries
Arm Injuries
Ulnar Neuropathies
Peripheral Nervous System Diseases
Neuromuscular Diseases
Nervous System Diseases
Cumulative Trauma Disorders
Sprains and Strains processed this record on September 21, 2017