Verification of importance of immediate tendon transfer in combination with group fascicular nerve repair versus nerve repair only in low combined ulnar and median nerve injury on hand functions

Abstract

Peripheral nerve injuries in the upper limb are common health problem. Combined median-ulnar nerve injury at the level of distal forearm (below the musculotendinous junction) is common, secondary to sharp trauma which occurs between 16 and 40 years of age. This led to loss of hand functions, joint deformity and loss of work. Treatment of these nerve injuries often requires group fascicular repair. In adults, degeneration of the motor end plate becomes irreversible after 12 to 18 months. Early tendon transfer has a definite place in the management of this injury, but there is still a need to decrease post-operative recovery time especially with manual workers, also adhesions and joint deformity, thus it is important to intervene as early as possible by immediate tendon transfer. In this study there were twenty patients with combined distal ulnar- median nerve injury divided into two equal groups. Group I (control) had primary (group fascicular) repair. Group II (study) had primary (group fascicular) repair in addition to immediate tendon transfer. Opponen-plasty was done using extensor indicies, while the adducto-plasty was done using extensor carpi radialis brevis with appropriate splinting and received postoperative rehabilitation according to the operation to promote healing and avoid median and ulnar nerve deformities as claw hand. Nerve conduction velocity and electromyophsiology were done at 3 and 6 months. Assessment of hand functions as powerful hand grip and hand pinch were done by dynamometer after 3 and 6 months. Opposition and any joint deformity was measured using goniometer. A comparison between two groups was done. As results there was no response of nerve regeneration of both nerve or partial response which means disturbed hand functions as powerful hand grip and hand pinch and so there was deformity in joints and opposition, which leads to deformity in hand functions. But in the six months assessment there was little improvement in regeneration so that needs to follow up patients to longer time than six months. But still there was great difference in hand grip, hand pinch, opposition and no deformity in any joints which is excellent in the study group. These make hand functions excellent, and so return patients to work very early in about three months, which return them to their normal life as early as possible.