A total of 58 patients with a displaced, distal humerus fracture undergoing bicolumnar plate fixation were randomized to receive a simple decompression (n=31) or anterior transposition (n=27) of the ulnar nerve. The ulnar nerve-related outcomes of interest included Jamar grip and pinch strength, the Semmes-Weinstein monofilament test, Jebsen test of hand function, and return to work and activities. Outcomes were assessed up to 2 years post-operation. No statistically significantly differences were observed in all outcomes between the two interventions 3 months post-operation. However, all outcomes did improve with time relative to baseline scores. Multivariable analysis demonstrated that triceps-sparing and tricep split approaches were predictive of a decrease in the tip pinch score (p=0.0146, p=0.0233, respectively) and grip strength (p=0.04, p=0.0013, respectively). Furthermore, tricep-sparing and tricep split approaches were predictive of an increase in the Jebsen hand test scores (p=0.003, p=0.007, respectively).