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.
Highlights
Traumatic isolated ulnar nerve injuries result in function loss of ulnar wrist, dig IV and V flexion, sophisticated complex hand movements and sensory loss in the hypothenar, half of dig IV and V
In this study we focus on high isolated clean sharp (HICS) ulnar nerve lesions defined as lesions 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
Based on our surgical results and those identified in the literature we present a rational for the treatment of HICS ulnar nerve lesions
Summary
Traumatic isolated ulnar nerve injuries result in function loss of ulnar wrist, dig IV and V flexion, sophisticated complex hand movements and sensory loss in the hypothenar, half of dig IV and V. The level of injury can roughly be divided into high or low, referring to the distance of the lesion to the sensory and motor end organs. The distal nerve transfer technique was introduced in which the anterior interosseus nerve is connected to the deep ulnar nerve motor branch for the surgical repair of ulnar nerve lesions [15], [16]. This technique can potentially be used to optimize outcomes of HICS ulnar nerve lesions. Based on our surgical results and those identified in the literature we present a rational for the treatment of HICS ulnar nerve lesions
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