When ulnar nerve lesions happen above the wrist level, sensation recovery after acute repair or nerve grafting is often challenging. Distal sensory nerve transfers may be an option for overcoming these sequelae. However, little data has been published on this topic. This study aims to review the surgical procedures currently proposed, along with their functional results. Six donor nerves have been described at the wrist level: the palmar branch of the median nerve, the cutaneous branch of the median nerve to the palm with or without fascicles of the ulnar digital nerve of the index finger, the posterior interosseous nerve, the third palmar digital nerve, the radial branch of the superficial radial nerve, the median nerve, and the fascicule for the third web space. Three donor nerves have been reported at the hand level: the ulnar digital nerves of the index, and the radial or ulnar digital nerves of the long finger. Three target sites were used: the superficial branch of the ulnar nerve, the dorsal branch of the ulnar nerve, and the ulnar digital branch of the fifth digit. All the technical points have been illustrated with anatomical dissection pictures. After assessing sensory recovery using the British Medical Research Council scale, a majority of excellent recoveries scaled S3+ or S4 have been reported in the targeted territory for each technique.

The aim of the present anatomical study was to assess the dorso-radial approach for percutaneous fixation of scaphoid wist fractures. Through the anatomical snuffbox, cannulated screws or 1.2 mm K-wires were inserted into the scaphoids of 20 fresh-frozen cadavers. No tendon injuries were observed. There were two lesions of the radial artery, and three lesions of the sensory branches of the radial nerve. After dissection and three-dimensional CT reconstruction, the K-wire or screw position was described in relation to the scaphoid centroid and its longitudinal axis. The mean distance between the device and the scaphoid centroid was 2.8 mm (SD 1.4, range 0.6 to 6.1). The mean angle between the device and the scaphoid’s longitudinal axis was 29° (SD 11, range 6.5 to 54). Rather than percutaneous fixation, an open approach with a modest incision might be safer for identifying and protecting both the radial artery and the sensory nerves. This approach would make perpendicular fixation possible for specific patterns of scaphoid fracture orientated approximately 60° from the longitudinal axis.