Primary Repair versus Reverse End-to-Side Coaptation by Anterior Interosseous Nerve Transfer in Proximal Ulnar Nerve...

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Hand Surgery
• Regenerative Medicine

Background:

• Proximal ulnar nerve lacerations present a significant clinical challenge due to the intricate sensory and motor functions they control in the hand.
• Effective surgical management is crucial for restoring hand function and preventing long-term disability.
• Current treatment strategies require evaluation for optimal patient outcomes.

Purpose of the Study:

• To compare the efficacy of primary repair (PR) versus primary repair plus anterior interosseous nerve (AIN) reverse end-to-side (RETS) coaptation for proximal ulnar nerve injuries.
• To assess functional recovery, strength, and pain levels following these surgical interventions.

Main Methods:

• A prospective cohort study included patients with isolated complete ulnar nerve lacerations treated between 2014 and 2018.
• Patients were divided into two groups: primary repair (PR) only or primary repair with AIN RETS coaptation (PR + RETS).
• Outcomes were evaluated at 6 and 12 months using the quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Medical Research Council (MRC) scores, grip and pinch strength, and visual analogue scale (VAS) pain scores.

Main Results:

• Sixty patients (28 PR, 32 PR + RETS) were analyzed, with no demographic or injury location differences between groups.
• The PR + RETS group showed significantly lower quick DASH scores at both 6 and 12 months postoperatively compared to the PR group.
• Grip and pinch strength were significantly greater in the PR + RETS group at both 6 and 12 months.

Conclusions:

• Primary repair combined with AIN RETS coaptation leads to superior grip and pinch strength.
• This combined surgical approach significantly improves upper extremity function compared to primary repair alone for proximal ulnar nerve injuries.
• AIN RETS coaptation represents a valuable adjunct to primary repair for optimizing outcomes in challenging proximal ulnar nerve injuries.