Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist

Abstract

A retrospective review of 42 patients with spaghetti wrist lacerations operated on by the author between June 1997 and May 2005 was completed. A total of 31 males and 11 females, average age of 17.1 years (range, 2-40 years), sustained spaghetti wrist injuries. The most frequent mechanisms of injury were accidental glass lacerations (55%), knife wounds (24%), and electrical saw injuries (11%). An average of 9.16 structures was injured, including 6.95 tendons, 1.4 nerves, and 0.8 arteries. The most frequently injured structures were median nerve (83%), flexor digitorum superficialis 2-4 tendons (81%), flexor digitorum profundus 2-4 tendons (66%), ulnar nerve and ulnar artery (57%), and flexor pollicis longus (40%). Combined flexor carpi ulnaris, ulnar nerve, and ulnar artery (ulnar triad) injuries occurred in 31%, while combined median nerve, palmaris longus, and flexor carpi radialis injuries (radial triad) occurred in 43%. Simultaneous injuries of both median and ulnar nerves occurred in 40.5%. Simultaneous injuries of both ulnar and radial arteries occurred in 14%. Neither artery was injured in 30.9%. Follow-up has ranged from 1 to 8 years, with an average of 46 months. Only four patients have been completely lost to follow-up. Range of motion of all involved digits (tendon function) was excellent in 34 patients, good in 3 patients, and poor in only 1 patient. Opposition was excellent in 31 patients, good in 5 patients, and poor in 2 patients. Intrinsic muscle recovery was subjectively reported to be excellent in 29 patients, good in 7, and fair to poor in 2 patients. Minor deformity (partial clawing) was reported in 4 patients and 1 patient has major deformity (total clawing). Sensory recovery was reported, excellent in 32 patients, good in 5 patients, and fair in only 1 patient.

Obstacles to the Care of Patients With Multicomponent Volar Wrist Lacerations at a County Hospital

“…Common patterns of injury include the "ulnar triad," with injury to the ulnar nerve, ulnar artery, and flexor carpi ulnaris, occurring in 31% to 42% of patients. [1][2][3] Similarly, the radial triad injury, with injury to the median nerve, palmaris longus, and flexor carpi radialis, is reported in 23% to 43% of patients. Studies vary in whether injury to the median nerve or ulnar nerve is more common, and simultaneous injury to both median and ulnar nerve ranges from 20% to 48%.…”

Salvage of Complete Degloved Digits With Reversed Vascularized Pedicled Forearm Flap: A New Technique

“…We assessed sensory recovery in 3 groups according to static 2-point discrimination: less than 10 mm (16 patients, 61%), greater than 10 mm (8 patients, 30%), and totally insensate (2 patients, 9%). 14 Finger range of motion was excellent in 18 fingers ( Fig. 2A, B), good in 7 (Fig.…”

Long term results of primary repair of combined cuts of median and ulnar nerves on forearm

“…Noamann in his own series reported that following combined cuts, 6.5% patients showed a major deformity,13.5% patients showed a minor deformity, and 80% showed no signs of deformity. [15] Hudson reported observing 7 claw deformities throughout the 49 months of follow-up in his 15 combined cut series. [16] Only two patients developed claw hand deformity in our series including 26 patients.…”