Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist.
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.
Noaman
Hassan H
HH
Hand and Reconstructive Microsurgical Unit, Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Egypt. hassan_h@mailcity.com
D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries / Q000601:surgery; D008866:Microsurgery; D009048:Motor Skills / Q000502:physiology; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D017534:Radial Artery / Q000293:injuries / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000601:surgery*; D017535:Ulnar Artery / Q000293:injuries / Q000601:surgery; D014459:Ulnar Nerve / Q000293:injuries / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery*; D014953:Wrist / Q000098:blood supply / Q000294:innervation; D014954:Wrist Injuries / Q000601:surgery*