TREATMENT OF POST-TRAUMATIC LATE ULNAR NEURITIS IN PATIENTS WITH FALSE JOINTS, OSTEOPOROSIS OF THE HEAD OF THE CONDYLE OF THE HUMERUS

Abstract

The opinions of scientists on the pathogenesis of the development of late neuritis of the ulnar nerve in patients with pseudarthrosis of the condyle head, valgus deviation of the forearm are described. The authors explained the pathogenesis of complication by narrowing of the groove of the nerve on the condyle (s. Ulnaris) and excursion of the nerve during flexion and extension, followed by the development of perineuritis and neuritis. Other authors expressed the opinion that the development of neuritis is associated with microtraumatization due to the pressing of a nerve to the internal epicondyle by the ulnar process and with the formation of an endoneural neuroma. In the treatment of fresh shoulder bone distal epiphyseal head (SBDEH) fractures with a plaster cast, secondary displacements of fragments are observed, delayed consolidation with the possible formation of a false joint, valgus deformation of the elbow joint (14), the development of aseptic necrosis (15.16), late neuritis of the ulnar nerve, osteoarthritis with severe pain syndrome (4) . The frequency of complications of HMPC fractures in children, according to different authors, ranges from 3.3% to 54.8%. In patients with overgrown fractures and pseudoarthrosis SBDEH, various types of operations are used: from open osteosynthesis to complex reconstructive, reconstructive, without or using the Ilizarov apparatus. Bone grafting was applied in the form of a lining of the pseudoarthrosis, in the form of a bone fixative as a screw, or for overlapping over the pseudoarthrosis. Hallux valgus deviation was eliminated by supracondylar osteotomy. According to the clinical observations of the authors, in patients with pseudoarthrosis of SBDEH with a long prescription, a bone defect in the centrally external part of the humeral epimetaphysis develops. The authors developed and put into practice the operation “replacing a bone defect with bone grafts from the diaphysis of the patient’s fibula”.                Purpose of the study. Description of the results of the treatment of pseudoarthrosis of SBDEH with osteoporosis using bone grafting, the results of neurolysis and transposition of the ulnar nerve anterior to the elbow joint.               Material and methods. The experience of surgical treatment is presented in 55 (5 - adults, 50 children) patients with surgery, bone replacement of a bone defect in the pseudoarthrosis of the pseudoarthrosis of SBDEH. In 30 patients, knitting needles (3-4) were used to fix the transplants and the fragment, with external immobilization by a plaster cast, in 80% of them bone fusion of the pseudoarthrosis was obtained, over a 2-3 month period. In 20% of patients, bone fusion was achieved after the Ilizarov apparatus was changed as stage 2, due to the fusion of the grafts from the metaphysis, but its absence between the graft and the HMPC fragment. They also received bone fusion of the pseudoarthrosis. Long-term results were studied on the basis of the developed criterion for evaluating the results of treatment taking into account the joint fusion, joint function, axis of the arm and the state of the growth zone.               Results: Of the 55 patients, 51 (90.2%) studied the long-term results of treatment ranging from 6 months to 10 years. Excellent results were obtained in 13 (25.5%), good in 30 (58.8%) patients, satisfactory in 8 (15.7%), and unsatisfactory results.