Status Saraf Ulnaris pada Pasien Pasca Tindakan Operasi Reduksi Terbuka Fiksasi Internal Fraktur Humerus Distal di Rsup Adam Malik Medan

Abstract

Background: Distal humerus fractures are complex injuries that often require open reduction with internal fixation (ORIF). One common complication is ulnar nerve injury, which has been reported to be related to the surgical approach. This study aimed to analyze the relationship between the type of surgical approach and the incidence of ulnar nerve injury after ORIF in distal humerus fractures. Methods: This observational, analytical, cross-sectional study was conducted on 45 patients who underwent distal humerus ORIF at Adam Malik General Hospital, Medan, between 2020 and 2024. Data were collected from medical records and postoperative neurological examinations using the McGowan classification. The surgical approaches studied were: paratricipital, triceps splitting, and Chevron osteotomy. Results: The mean age of the patients was 42.02±12.46 years, with the majority being male (60%). The most common mechanism of injury was falls (46.67%). The paratricipital approach was most frequently used (44.44%), followed by Chevron osteotomy (35.56%) and triceps splitting (20%). Postoperative ulnar nerve injury was found in 3 patients (6.67%), with the highest incidence proportionally in the triceps splitting approach (11.1%). Kolmogorov-Smirnov analysis showed a non-significant association between surgical approach and ulnar nerve injury (p = 0.786). Conclusion: No significant association was found between the ORIF surgical approach and the incidence of ulnar nerve injury. This finding can be used as a consideration in selecting a safe surgical approach to the ulnar nerve in distal humerus fractures.