Dr.K.Natramizh(1);Dr.K.Sathish Kumar(2);Prof.K.Saravanan(3)

Abstract

Spaghetti wrist refers to forearm or wrist level volar laceration, in which at least 3 to 10, out of 16 structures including flexor tendons, median and ulnar nerves and radial and ulnar arteries are injured. This complex injury may lead to detrimental effects on hand function and psychosocial and economic consequences. MATERIALS AND METHODS  The patients who underwent treatment for spaghetti wrist , within 24 hours of injury, in our institute during the period of July 2021 to December 2022 were included. Patient demographics, etiology of the injury, operative technique, post operative rehabilitation protocol and functional outcomes are discussed. Functional recovery was measured in terms of sensation, flexor tendon function, opposition, intrinsic muscle recovery and grip strength.
RESULTS  48 males and 8 females, with a total of 56 patients were included in this study. The mean age was 39 years. The most common etiology was work spot injury and with Right side involvement in 40 patients and left side involvement in 16 patients.
Flexor tendon injuries were noted in all the patients. Both median and ulnar nerve injuries were noted in 14 patients. Median nerve injury were noted in 22 patients. Ulnar nerve injury was noted in 20 patients. Ulnar artery was repaired in 22 patients. Radial artery was repaired in 8 patients. During the follow up, hand sensation was excellent in 20% and good in 52% and fair in 18%. Motor recovery of Flexor tendon function in 78%, opposition in 75% and intrinsic function in 30% were excellent.
CONCLUSIONS  Patients have good functional recovery with immediate exploration and primary repair of injured structures in spaghetti wrist. Median nerve recovery is better when compared to ulnar nerve. When ulnar arterial repair is done along with ulnar nerve repair, recovery of the nerve function is better. Secondary procedures like tenolysis and neurolysis are common in patients who have no regular physiotherapy and follow up.