Proximal median and ulnar nerve lesions: results of primary and secondary repair on 66 cases

Purpose of the study Recovery after median and ulnar nerve proximal repair is widely appreciated , The place and time for secondary Material and method From January 1983 to January 1990, 66 patients suffering from proximal inju ry of the median or ulnar nerves underwent nerve repair, Forty-five patient s had a postoperative follow-up of more than 24 months: 24 isolated ulnar n erve lesions, 12 isolated median nerve lesions, and 9 combined median and u lnar nerve lesions. Ten patients were given a primary microsurgical nerve s uture in our department. Thirty-eight patients underwent a delayed or secon dary nerve repair of one or both nerves. 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. Results Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondar y sutures, although 40 per cent of patients treated with nerve grafts get f inal "good" or "very good" results. The time between the injury and nerve r epair was the most significant prognosis factor. Results of ulnar nerve rep airs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005), Fourteen patients required seconda ry functional reconstruction, Tendon transfers were performed at least 24 m onths after nerve repair. Discussion Nerve repair of proximal lesion to the median or ulnar nerves depends on th e type of injury, but is advised even when delayed. Residual deficit follow ing nerve repair should require functional transfers depending on hand sens itivity and extrinsic function.