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Ulnar Neuropathy
The ulnar nerve is vulnerable during the surgical management of elbow trauma, in particular for fractures of the distal humerus. The ulnar nerve is identified and protected during the fixation of distal humerus fractures, the fixation of coronoid fractures, and medial-sided soft-tissue procedures for elbow instability. The techniques used to protect the ulnar nerve during surgical management of a traumatized elbow vary by surgeon. Many surgeons unroof the ulnar nerve so that it can be visualized and, essentially, decompressed in situ. Alternatively, the ulnar nerve may be elevated with the surrounding soft-tissues during subperiosteal dissection under the medial elbow capsule, allowing for retraction during fracture fixation. Other surgeons unroof and circumferentially dissect around the ulnar nerve during exposure to allow for transposition into the subcutaneous tissues for the remainder of the procedure. Regardless of the initial management of the ulnar nerve, there is no consensus as to whether the ulnar nerve should be transposed anteriorly or left in its native position at the conclusion of the procedure.