Epidemiology and Classification of Extensive Volar Wrist Lacerations: The "Spaghetti Wrist"

Abstract

Objective: The aim of this study is to analyze the local epidemiological data, redefine and classify spaghetti wrist injuries as well as compare and contrast the prognostic implications of our classification with those in the literature. Methods and Results: A review of surgical records between January 1991 and December 2002 found 164 men (82.8%) and 34 women (17.2%), with a mean age 27.5 years, were operated for spaghetti wrist lacerations. The frequency of spaghetti wrist was 16.5/year or 1.4/month. The annual rate of spaghetti wrists increased from 6.6% during 1991 to 1995, to 9.3% during 1996 to 2000, and to 10.4% during 2001 to 2002. Under 40 years, the women were 3.7 years younger than men were. Most frequent mechanism of injury was assault cutlass lacerations (39.4%). The ulnar nerve (73.1%), flexor carpi ulnaris (68%), and ulnar artery (61.7%) were the most commonly injured structures. In grade-1, ulnar triad structures were more commonly injured (46.3%) than the combined central superficial structures (33.3%). In Grade-3, most volar structures were transected. Delayed primary and secondary repairs were highest in grade-3 crush/avulsive (44.8%) spaghetti wrists. To include all variants, the spaghetti wrist was redefined as those extensive volar wrist lacerations occurring between the distal wrist crease and musculotendinous junctions, involving a minimum of three volar structures (nerve, artery and a tendon) to at least ten structures, with or without one or more extensor tendons and bones. Conclusions: This study shows that, there is an increase in spaghetti wrist injuries in our population over the last 5 to 8 years. Comprehensive definition and classification of spaghetti wrists can help in the study of the functional outcomes of all variants of this injury and thus develop better treatment protocols.