Early rehabilitation of victims of traumatic ulnar injury using tendon transfer

Abstract

BackgroundPoor awareness among the patients and lack of resources for proper management of nerve injuries leads to delayed presentation of most traumatic ulnar nerve injuries. When this injury is present in the proximal forearm it leads to poor outcomes as Ulnar nerve repair with grafts takes a prolonged time to restore function. Addition of a tendon transfer to this procedure can allow patients to return to work earlier. The purpose of this study is to examine whether the addition of a tendon transfer to nerve repair surgery will lead to improved hand function and rehabilitation earlier than nerve grafting alone in cases of delayed presentation of Ulnar nerve injuries. MethodsA retrospective analysis of patients with traumatic ulnar nerve injury with duration of injury more than 1 month and location > 5 cm proximal to the flexor retinaculum who required a sural nerve graft for repair was done using Sollerman Hand Function test (SHFT). The SHFT scores were recorded for these patients at end of one year following repair with nerve grafting and status of employment at end of 6 and 12 month of surgery recorded as well. Another group of patients with traumatic ulnar injury of the same profile were given Fritchi tendon transfer along with sural nerve graft and followed up prospectively for a period of one year and SHFT score with status of employment recorded. ResultsOn comparison of employment status at 6 months we found that among the tendon transfer group 15/20 (75%) were employed while only 4/16 (20%) in the control group were able to return to work. Chi square test shows a p value of 0.002 (significant at p < 0.05). On evaluation at end of 1 year after surgery we found 18/20 (90%) had returned to work in the tendon transfer group while 8/16 (50%) had found employment again in the control group. Chi square test shows a p value 0.007 (significant at p < 0.05) ConclusionThese outcomes suggest that addition of a tendon transfer with nerve grafting promotes early rehabilitation, especially in patients employed in manual labor.