Outcome following Nerve Repair of High Isolated Clean Sharp Injuries of the Ulnar Nerve

Abstract

ObjectiveThe detailed outcome of surgical repair of high isolated clean sharp (HICS) ulnar nerve lesions has become relevant in view of the recent development of distal nerve transfer. Our goal was to determine the outcome of HICS ulnar nerve repair in order to create a basis for the optimal management of these lesions.MethodsHigh ulnar nerve lesions are defined as localized in the area ranging from the proximal forearm to the axilla just distal to the branching of the medial cord of the brachial plexus. A meta-analysis of the literature concerning high ulnar nerve injuries was performed. Additionally, a retrospective study of the outcome of nerve repair of HICS ulnar nerve injuries at our institution was performed. The Rotterdam Intrinsic Hand Myometer and the Rosén-Lundborg protocol were used.ResultsThe literature review identified 46 papers. Many articles presented outcomes of mixed lesion groups consisting of combined ulnar and median nerves, or the outcome of high and low level injuries was pooled. In addition, outcome was expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for further analysis. In our institution, 15 patients had nerve repair with a median interval between trauma and reconstruction of 17 days (range 0–516). The mean score of the motor and sensory domain of the Rosen's Scale instrument was 58% and 38% of the unaffected arm, respectively. Two-point discrimination never reached less then 12 mm.ConclusionFrom the literature, it was not possible to draw a definitive conclusion on outcome of surgical repair of HICS ulnar nerve lesions. Detailed neurological function assessment of our own patients showed that some ulnar nerve function returned. Intrinsic muscle strength recovery was generally poor. Based on this study, one might cautiously argue that repair strategies of HICS ulnar nerve lesions need to be improved.

Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

“…This is in part due to the large number of axons required to power the hand intrinsics as well as the distance required for axons to regenerate before reaching their motor endplate targets. As such, ulnar nerve injuries proximal to the elbow have an especially poor prognosis 55 61. To improve the results after such injuries, the anterior interosseous nerve (AIN) branch to the pronator quadratus (PQ) has been used to selectively innervate the motor branch of the ulnar nerve 41 53 54 56.…”

The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers

“…Tinel believed that late worsening of clawing is related to loss of tonus of the paralyzed interosseous muscles . Recently, Post et al revised the literature on outcomes of the repair of sharp lesions of the ulnar nerve around and above the elbow. Surgeons had assumed that traumatic isolated ulnar nerve injuries had resulted in loss of flexion of the distal phalanx of the ring and little fingers.…”

Functional and electrophysiological outcome after autogenous vein wrapping of primary repaired ulnar nerves

“…Surgical repair of ulnar nerve lesions do relatively poor as compared, for instance, to the radial and median nerves. 17 In 1991, Birch and Raji had conducted a detailed and comprehensive study on 108 median and ulnar nerve injuries that were managed by either primary, delayed repair, or grafting. They concluded that primary repair is the best with achieving a few excellent results particularly in young age patients.…”