Outcomes of radiocarpal pinning to facilitate nerve repair in wrist level ulnar nerve injuries with defect.

Abstract

The ideal scenario for ulnar nerve repair is primary end-to-end neurorrhaphy in a tension-free environment. However, this could be complicated by soft tissue loss, scarring and neuroma formation in a delayed injury, creating a nerve defect. With a wrist level nerve defect, a flexion position can help shorten the nerve gap. However, maintaining the position can be challenging intraoperatively and postoperatively. We proposed our method previously of using a 1.6mm K wire for radio-lunate-capitate pinning of the wrist in flexion to minimize the nerve gap, thereby facilitating neuroma excision and end-to-end neurorrhaphy in delayed ulnar nerve injury. In this study, we elaborate our method and present our case series. From October 2018 to July 2020, 5 patients (mean age: 48.2 years; mean delay from injury to surgery: 84.6 days; mean follow-up: 17.5 months) were retrospectively reviewed. The mean flexion fixation angle was 52 degrees and the K wire was removed at an average of 5.1 weeks postoperatively. All patients were followed-up for a minimum of 12 months. All patients achieved M4 and S3 or S3+ neurologically (according to the criteria of the Nerve Injuries Committee of the British Medical Research Council). The mean Disabilities Arm Hand and Shoulder score was 14.1. The mean grasp and pinch strengths were, respectively, 76.8% and 63.6% of the contralateral hand. All wrist range-of-motion returned to normal within 12 weeks. No complications were noted intraoperatively or postoperatively. Our study showed that radiocarpal pinning of the wrist in flexion was safe and convenient to minimize the nerve gap and to facilitate end-to-end neurorrhaphy in limited-sized wrist-level ulnar nerve defects.