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

Abstract

"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.