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Spaghetti wrist: management and outcome
Azhar Jawaid Bukhari1, Mohammad Saleem, Aamer Riaz Bhutta
1Department of Surgery, Sir Ganga Ram Hospital, Lahore. azhar104@hotmail.com
Insights
Emergency management of spaghetti wrist injuries through immediate primary repair yields good outcomes. Effective physiotherapy and patient compliance are crucial for optimal functional recovery and wrist joint mobility.
Area of Science:
- Hand surgery
- Trauma surgery
- Microsurgery
Background:
- The 'spaghetti wrist' describes sharp, clean-cut volar forearm lacerations involving multiple vital structures.
- Prompt surgical intervention is critical for preserving function in these complex injuries.
Purpose of the Study:
- To evaluate the outcomes of emergency management for spaghetti wrist injuries.
- To assess the efficacy of immediate primary repair in restoring function.
Main Methods:
- A descriptive study was conducted on 10 patients (aged 14-38 years) with spaghetti wrist injuries treated within 6 hours.
- Follow-up included clinical assessment and nerve conduction studies over one year.
- Recovery was evaluated using standardized scales for sensory, motor, and tendon function.
Main Results:
- Accidental injuries, often from broken glass or kite strings, involved an average of 8.2 structures per patient.
- Median and ulnar nerves were frequently involved, alongside wrist flexors.
- All patients achieved full range of motion and power in wrist joints, with good overall functional results.
Conclusions:
- Immediate primary repair of spaghetti wrist injuries is a safe and effective treatment.
- Good physiotherapy, close follow-up, and patient compliance significantly influence outcomes.
- Clinical and functional assessments are more appropriate for evaluating recovery than neurophysiological studies alone.
Objective:
To determine the outcome of emergency management of the spaghetti wrist.
Design:
Descriptive study.
Place And Duration Of Study:
Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003.
Patients And Methods:
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.
Results:
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.
Conclusion:
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.
