Spaghetti Wrist Research Articles

Spaghetti Wrist Trauma: Functional Recovery, Return to Work, and Psychological Effects

Spaghetti Wrist Trauma: Functional Recovery, Return to Work, and Psychological Effects

Spaghetti Wrist Trauma: Functional Recovery, Return to Work, and Psychological Effects

Few studies on spaghetti wrist trauma have been published. The study populations have all consisted of small numbers of patients, and most studies have focused on functional recovery. In addition, different definitions of this injury have been used. The objective of this study was to assess outcome for a larger group of patients in terms of functional recovery, return to work potential, and psychological distress, and to compare outcomes between the two most commonly used definitions for spaghetti wrist injury. The initial study-population consisted of 67 patients. Fifty patients completed a questionnaire package consisting of the Disabilities of Arm, Shoulder, and Hand questionnaire, including the Functional Symptom Score (range, 0 to 100), a questionnaire to evaluate return to work and time off work (range, 0 to 52), and the Impact of Event Scale (range, 0 to 75). Motor recovery and sensory recovery were assessed in an outpatient setting, on average, 10 years (range, 2 to 18) after the operation (n = 43). The mean Functional Symptom Score was 15.1 (SD, 16.1; range, 0 to 74) after a mean follow-up of 10.0 years (SD, 4.4; range, 2 to 18). Mean time off work was 34.7 weeks (SD, 17.9; range, 4 to 52), and 45.2 percent of the patients could not return to work within 1 year after the injury. Mean score on the Impact of Event Scale was 26.2 (SD, 19.7; range, 2 to 69). Compared with the unaffected hand, grip and tip pinch strength were decreased with means of 23.5 percent (SD, 22.4; range, 0 to 93) and 33.9 percent (SD, 23.7; range 0 to 83), respectively. Regarding sensory recovery, 12 patients (27.9 percent) had no protective sensation. No statistical differences were found between the two different definitions. This study demonstrated that spaghetti wrist injury can be placed among the severe disabling injuries. Comparison of the two definitions did not reveal any differences in outcome. To complete the evaluation of long-term outcome, a patient-derived assessment of function can be added to the clinical examination, and attention should be paid to psychological distress following the injury.

Spaghetti wrist: management and outcome.

To determine the outcome of emergency management of the spaghetti wrist. Descriptive study. Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003. During this period, all patients of more than 12 years, with sharp clean cut volar forearm lacerations (spaghetti wrist) of <6 hours were included, with a follow-up of one year, clinically and with nerve conduction studies, where appropriate. Sensory and motor recovery was evaluated according to S0-S4 and MRC (medical research council) scale respectively. The power of first dorsal interosseous and adductor pollicis was used to monitor the recovery of ulnar nerve; and abductor pollicis brevis and opponens pollicis for the median nerve. The tendon recovery was evaluated by Strickland Adjusted System Score. This study comprised of 10 patients (M:F, 4:1), of 14 to 38 years (mean 22.9 years). Injury was accidental in 70%; due to broken glass in 50% and kite string in 40%; involving right hand in 70%. 8.2 (4-12) structures per patient were involved. The injury involved median nerve in 70%, ulnar nerve in 60%, (30% had both nerves involved), flexor carpi ulnaris in 70%. There was predilection of injury for medial structures. In 80%, wrist flexors were involved, and all wrist joints recovered to the full range of movements and power. The ulnar nerve showed less total motor and sensory recovery than median nerve. However, sensory and motor recovery was good. Overall functional results were good and did not correlate with neurophysiological studies. Immediate primary repair is safe and has good outcome, which also depends upon good physiotherapy, close follow-up and patients' compliance. Overall clinical and functional assessment is more appropriate than series of individual observations and neurophysiological studies.

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

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.

Secondhand management of "spaghetti wrist": do not hesitate to explore.

"Spaghetti wrist" consists of the severance of at least three structures, of which one is the median nerve or the ulnar nerve, and it is one of the most devastating injuries of the hand. Close follow-up and appropriate rehabilitation are mandatory for management; however, this is not easy in patients whose previous treatment was accomplished elsewhere. The authors explored 28 patients with spaghetti wrist injuries who were previously operated. The study included those with areas of the hand, innervated by the injured nerve, that were partially or completely anesthetic. Limited sensorial return was also uniform and partial anesthetic sites were usually limited to only a finger or either side of a finger. When explored, six nerves had a normal appearance and 18 nerves had neuroma-in-continuity on their repair sites. The median nerves of the remaining five patients had been repaired not to their original proximal or distal stumps, but to adjacent tendons. A nerve tissue bridge from the proximal to the distal stump developed in all these patients. The authors conclude that hand surgeons should explore the previous repair sites if they have any suspicions regarding the technique performed and the success of previous management of spaghetti wrist. Any partial sensorial return to a limited area may be the result of axonal secondary pathways; thus, early exploration during the critical period can protect these patients from paralyzing sequelae of the injured nerves.

Results of treatment of the extensive volar wrist lacerations: 'the spaghetti wrist'.

'Spaghetti wrist' describes a volar wrist laceration in which at least 10 structures, inclusive of tendons, at least one major nerve and usually one major vessel are divided. This retrospective study, was performed between January 1990 and December 1995 at the Department of Orthopaedic and Traumatology of Erciyes University Medical School. The outcome of 21 patients who sustained simultaneous laceration of the median and ulnar nerves as well as flexor tendons at the wrist is described. The mean follow-up was 6.4 years. The flexor tendons were assessed using criteria from Lister et al. Vascular status was assessed clinically. Ulnar and median nerve repair results at the final control were assessed according to Seddon's criteria. Furthermore, the ulnar nerve was assessed according to the power of the first dorsal interosseous muscle, and the median nerve assessed by the function of abductor pollicis brevis and sensory function modality. Primary nerve repair yielded satisfactory results, the median nerve repair achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement at the final control.

A prospective study of flexorivendon repair in zone 5

A prospective study,of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension — active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorurn profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion. No rupture of an FDP tendon repair occurred during the study period. The data allowed us to define a new method of classifying the results of treatment of these injuries in terms of the injured wrists as a whole and not simply as a series of isolated observations for each individual finger with divided flexor tendons. The results of recovery of independent FDS action and range of finger movement achieved for injuries in which the flexors of all four fingers had been divided indicate a statistically significant interdependence of injuries of finger flexors of adjacent fingers at the wrist. Multivariate analysis showed the presence of a “spaghetti wrist” injury to have a significant adverse effect on the recovery of the independent FDS action but not on the recovery of the digital range of motion.

The spaghetti wrist: Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist

The outcome of 15 patients who sustained simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist is described. Primary nerve repair yielded satisfactory results, the median nerve achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement. Flexor tendons yielded the poorest results. A functional, albeit impaired outcome can usually be anticipated following this severe injury.

Results of Treatment of Extensive Volar Wrist Lacerations: The Spaghetti Wrist

Results of Treatment of Extensive Volar Wrist Lacerations: The Spaghetti Wrist

Results of treatment of extensive volar wrist lacerations: the spaghetti wrist.

A series of 38 volar wrist lacerations is reviewed with regard to epidemiologic aspects and results. In general, return of tendon function was quite good, and return of nerve function in this series was also satisfying. We attribute the generally good results to immediate repair of all structures, microscopic repair of significant arterial injuries, microscopic grouped fascicular nerve repair, early mobilization (dynamic splinting and intensive occupational therapy), and a generally youthful group of patients. Review of this series has strengthened our opinion that aggressive primary repair of all injured structures is appropriate for these extensive lacerations.