Combined nerve, vessel, and tendon injuries of the volar wrist: Multidisciplinary treatment and functional outcomes

Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?

“…Although these two groups of patients had injuries at different segments of the forearm, which indicated different reconstruction strategies against tendon or muscle laceration and different rehabilitation programs, with at least one major artery and one major nerve involved, a significant difference was only observed in surgical time (1.8±0.4 h to 2.1±0.4 h, t=2.455, p=0.018) (Table IV) and grip strength at the final follow-up (χ 2 =7.557, p=0.023) (Table V) between the wrist injury group and forearm injury group under the same rehabilitation program as described by Boynuyogun et al[ 6 ]…”

“…Although these two groups of patients had injuries at different segments of the forearm, which indicated different reconstruction strategies against tendon or muscle laceration and different rehabilitation programs, with at least one major artery and one major nerve involved, a significant difference was only observed in surgical time (1.8±0.4 h to 2.1±0.4 h, t=2.455, p=0.018) (Table IV) and grip strength at the final follow-up (c 2 =7.557, p=0.023) (Table V) between the wrist injury group and forearm injury group under the same rehabilitation program as described by Boynuyogun et al [6] Similar sex ratio, distribution of mechanism of injury, distribution of fixation, distribution of frequently involved tendon, artery and nerve, and classification of number and type of laceration and type of repair were seen in both groups, while it did not reach statistical significance. Also, there was no significant difference in the aspects of age, time before emergency, time before surgery, time for emergency hospitalization and DASH score at the final follow-up.…”

“…Passive and active tendon exercises as well as physical rehabilitation protocol were presented according to Boynuyogun et al[ 6 ] (Table II). All patients stick to the follow-up plan at one, three, and six weeks, and later every month after the initial surgery, unless specific complications occurred which needed closer observation.…”

“…Postoperative physiotherapy protocol of spaghetti wrist [6] Weeks 1-4 5-6 An axial longitudinal forearm exposure was performed incorporating with the initial transverse wound and the carpal tunnel was opened during severe transected ends retraction for adequate tissue identification and reconstruction. After precise dissection, all transected structures were identified and grouped for step-by-step repair through flexor digitorum profundi, flexor pollicis longus, arteries and vessels, flexor digitorum superficialis (FDS), flexor carpi and palmaris longus (PL).…”