No abstract

IMPORTANCE Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown. OBJECTIVE To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation.

lnar neuropathy at the elbow (UNE) is the second most common compression neuropathy after carpal tunnel syndrome, with an estimated incidence of 22 to 32 per 100,000 person-years. [1][2][3] Initial symptoms generally consist of pain and paresthesias in the ring and small fingers, eventually progressing to irreversible intrinsic muscle weakness and atrophy. 4,5 Although mild disease can be treated nonoperatively, progressive or moderate to severe cases are best managed surgically. [6][7][8][9] Regardless of the treatment chosen, patients with advanced disease often experience incomplete symptom relief after surgery. [10][11][12][13][14][15][16] Longer duration of symptoms has been associated with worse surgical outcomes, 16,17 suggesting that prompt surgical treatment is important for optimizing results. However, the early symptoms of UNE are better tolerated than in other compression neuropathies, such as carpal tunnel syndrome, 18,19 possibly causing clinicians to underestimate the severity of disease based on clinical assessment alone. Background: Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury. Methods: This prospective multicenter study recruited 78 patients in the Surgery of the Ulnar Nerve project. Patients underwent electrodiagnostic testing and clinical assessment of motor and sensory function, and completed patientreported outcome questionnaires, including the Michigan Hand Outcome Questionnaire; the Disabilities of the Arm, Shoulder and Hand questionnaire; and the Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed. Results: Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the Michigan Hand Outcome Questionnaire; Disabilities of the Arm, Shoulder and Hand questionnaire; CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with two-point discrimination or Semmes-Weinstein monofilament testing. Conclusions: CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making.