Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma

Abstract

Introduction: Ulnar nerve injuries around the wrist resultin paralysis of intrinsic muscles and sensory loss of littlefinger and ulnar half of ring finger. Formation of traumaticneuroma of the ulnar nerve adds pain at the site of nerverepairs.Patients and Methods: 10 patients were included in thisstudy. Clinical, radiological and electrophysiological assessmentindicate surgery in these patients where neuroma wasexcised, identification of sensory and motor fascicles of theulnar nerve was done and cable nerve grafts were used tobridge the nerve defects. Assessment of the outcome was donein patients who finished follow-up for at least one year.Results: Pain at the site of neuroma disappeared aftersurgery. All patients were followed-up and 6 patients neededtendon transfer after one year. Sensory recovery was achievedafter one year. Trophic changes and cold intolerance wasimproved.Discussion: Primary repair of ulnar nerve injuries is thegold standard treatment for such injuries. Claw hand, weaknessof the hand grip and abduction deformities are the main motordefects which can be corrected by tendon transfers. However,sensory defects and cold intolerance affected the outcome ofsurgery. When the diagnosis of non-conducting neuroma ismade, neuroma resection and reconstruction improve theclinical outcome.Conclusion: The unfavorable outcomes of ulnar nerveinjuries can be improved by resection of neuroma in continuityand nerve grafting. Multidisciplinary team is needed to achievethe best clinical outcomes.