Combined nerve, vessel, and tendon injuries of the volar wrist: Multidisciplinary treatment and functional outcomes

The superficial location of critical structures, including tendons, nerves and vessels, in the volar surface of the wrist makes them vulnerable to penetrating trauma. Extensive injuries to these structures are described as “spaghetti wrist”. The main objective of this study was to report functional outcome in spaghetti-wrist injuries. The records of patients presenting to our clinic with extensive volar wrist injuries between January 2016 and January 2019 were reviewed retrospectively. Age, gender, comorbidities, date of injury, injury mechanism, affected hand and transected structures were noted. Tendon function, opposition, intrinsic hand function, deformity and sensitivity were evaluated following the Noaman report. The Michigan Hand Outcomes Questionnaire (MHOQ) was used to evaluate hand-specific outcomes. Twenty patients were included. Mean age was 32.7 years (range, 18–47 years). Mean follow-up was 21.9 months (range, 12–50 months). Mean number of injured structures was 11.9 (range, 10–16 structures) per patient. Physiotherapy duration had an effect on postoperative outcome in all six MHOQ domains (r = 0.821, p = 0.00001). However, no significant difference in overall hand function was found according to the number of injured structures (r = −0.105, p = 0.661). Precise initial evaluation, meticulous surgical treatment within 24 h and early physical therapy are essential after spaghetti-wrist injury. Good functional results are associated with prolonged physical therapy, but not with the number of structures injured. La situation superficielle des structures anatomiques, notamment les tendons, les nerfs et le système vasculaire, à la face palmaire du poignet les rend vulnérables aux traumatismes pénétrants. Les lésions étendues de ces structures sont décrites comme “poignet spaghetti”. L'objectif principal de cette étude était de rapporter les résultats fonctionnels des lésions du poignet spaghetti dans une approche multidisciplinaire. Les dossiers des patients qui s’étaient présentés dans notre structure pour d'importantes lésions palmaires au poignet entre janvier 2016 et janvier 2019 ont été revus rétrospectivement. L'âge, le sexe, les comorbidités, la date et le mécanisme de la blessure, la main touchée et les structures sectionnées ont été notés. La fonction motrice, l'opposition, la fonction intrinsèque de la main, la déformation et la sensibilité ont été évaluées selon le rapport Noaman. Le Michigan Hand Outcomes Questionnaire (MHOQ) a été util