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Influence of Pre-Existing Cervical Radiculopathy on Cubital Tunnel Syndrome Development Following Distal Humerus Fractures
Nirav K Mungalpara, M.D.
1; Logan P Van Poucke, B.S.
1; Brett Drake, B.S.
1; Apurva Choubey, M.D.
1; James Oosten, M.D.
1; Abhishek Deshpande, M.D.
1; Benjamin Goldberg, M.D.
1; Alfonso Mejia, MD
2; Mark Gonzalez, MD, PhD
31University of Illinois at Chicago, Chicago, IL; 2Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL; 3University of Illinois at Chicago, Department of Orthopaedic Surgery, Chicago, IL
Objective: Cubital tunnel syndrome (CuBTS) results from ulnar nerve compression at the elbow, causing symptoms of numbness, weakness, and pain. Distal humerus fractures (DHF) can trigger ulnar nerve issues, even in previously asymptomatic individuals. Despite research on CuBTS after DHF, the role of pre-existing cervical radiculopathy (CR) remains unclear. This study examines how pre-existing CR influences CuBTS development post-DHF on a large scale.Methods: Data from 165 million patients in the PearlDiver database were categorized by DHF type: closed, open, or complicated (non-union or malunion). Patients with prior CR were sorted into these cohorts. We compared CuBTS development between patients with and without pre-existing CR, using a five-year Kaplan-Meier curve to analyze CuBTS occurrence post-DHF. Additionally, we assessed the likelihood of CR in patients who developed CuBTS after DHF compared to those who did not.Results: Cohorts were matched by age, ECI, gender, hypertension, diabetes, and obesity at a 1:5 ratio for fracture type. Among those with pre-existing CR, the odds ratio (OR) for developing CuBTS after closed DHF was 2.1 (95% CI = 1.9–2.25), after open DHF was 1.8 (95% CI = 1.4–2.53), and after complicated DHF was 1.92 (95% CI = 1.55–2.38) (Figure 1). Kaplan-Meier curves (Figure 2) demonstrated a significant association between CR and CuBTS post-DHF.Figure 3 compares CuBTS incidence between DHF patients with and without CR. The odds of CR diagnosis were 2.18 (95% CI = 2.29–2.08) following closed DHF, 2.09 (95% CI = 2.65–1.64) following open DHF, and 2.24 (95% CI = 3.04–1.65) following complicated DHF.Conclusions: Patients with pre-existing CR face significantly higher risks of CuBTS following DHF of all types. Similarly, CuBTS occurrence after DHF increases the likelihood of CR diagnosis. These findings underline the importance of cervical spine evaluations in DHF patients to effectively anticipate and manage potential nerve complications.
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