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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 5, 657-661.
doi: 10.1302/0301-620X.90B5.19820  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The assessment of the ulnar nerve at the elbow by ultrasonography in children

P.-C. Shen, MD, Orthopaedic Surgeon1; T.-C. Chern, MD, Orthopaedic Surgeon2; K.-C. Wu, MD, Orthopaedic Surgeon3; T.-W. Tai, MD, Orthopaedic Surgeon4; and I.-M. Jou, MD, PhD, Professor4

1 Department of Orthopaedic Surgery, Tainan Hospital, Department of Health, Executive Yuan, No. 125, Jhongshan Road, Tainin City, 700 Taiwan.
2 Chern Tai-Chung’s, Orthopaedics Clinic, No. 370, Boai Road, Ping-Tong City, 900 Taiwan.
3 Department of Orthopedics, Kuo’s General Hospital, No. 22, Sec. 2, Minsheng Road, Tainin City, 700 Taiwan.
4 Department of Orthopedics, National Cheng Kung University, College of Medicine, No. 138 Sheng Li Road, Tainin City, 704 Taiwan.

Correspondence should be sent to Professor I.-M. Jou; e-mail: jming{at}mail.ncku.edu.tw

We evaluated the morphological changes to the ulnar nerve of both elbows in the cubital tunnel by sonography in a total of 237 children, of whom 117 were aged between six and seven years, 66 between eight and nine years, and 54 between ten and 11 years. We first scanned longitudinally in the extended elbow and then transversely at the medial epicondyle with the elbow extended to 0°. We repeated the scans with the elbow flexed at 45°, 90°, and 120°. There were no significant differences in the area of the ulnar nerve, but the diameter increased as the elbow moved from extension to flexion in all groups. More importantly, the ulnar nerve was subluxated anteriorly on to the medial epicondyle by 1.5% to 1.9% in extended elbows, by 5.9% to 7.9% in those flexed to 45°, by 40.0% to 44% in those flexed to 90°, and by 57.4% to 58.1% in those flexed to 120°, depending on the age group. Sonography clearly and accurately showed the ulnar nerve and was useful for localising the nerve before placing a medial pin. Because the ulnar nerve may translate anteriorly onto the medial epicondyle when the elbow is flexed to 90° or more, it should never be overlooked during percutaneous medial pinning.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General