Ulnar Nerve Injury after Flexor Tendon Grafting

Area of Science:

• Orthopedic surgery
• Nerve reconstruction
• Tendon graft procedures

Background:

• Two-stage tendon reconstruction is a complex surgical procedure.
• Postoperative complications can arise, impacting functional recovery.
• Ulnar nerve palsy is a potential risk in hand and wrist surgeries.

Observation:

• A 43-year-old female developed low ulnar nerve palsy after a two-stage tendon reconstruction.
• Surgical exploration revealed the tendon graft had passed through Guyon's canal.
• The ulnar nerve was found to be divided during the exploration.

Findings:

• This represents a previously unreported complication of two-stage tendon reconstruction.
• Incorrect tissue plane identification during graft passage can lead to iatrogenic ulnar nerve injury.
• The tendon graft's aberrant path through Guyon's canal was the direct cause of the nerve palsy.

Implications:

• Highlights the critical importance of meticulous surgical technique in tendon reconstructions.
• Emphasizes the need for precise anatomical landmark identification to prevent nerve damage.
• Provides a cautionary note for surgeons regarding potential graft misplacement and its consequences.