SPAGHETTI WRIST - MANAGEMENT AND RESULTS

A retrospective review of 60 patients with ''spaghetti wrist'' lacerat ions operated on by the authors between July of 1988 and June of 1996 was completed. Spaghetti wrist injuries were defined as those occurrin g between the distal wrist crease and the flexor musculotendinous junc tions involving at least three completely transected structures, inclu ding at least one nerve and often a vessel. A total of 41 men and 19 w omen, average age of 29.0 years (range, 5 to 54 years), sustained spag hetti wrist injuries. The most frequent mechanisms of injury were acci dental glass lacerations (61.0 percent), knife wounds (23.7 percent), and suicide attempts (8.5 percent). An average of 7.8 structures were injured including 5.8 tendons, 1.2 nerves, and 0.73 arteries. The most frequently injured structures were flexor carpi ulnaris (66.7 percent ), median nerve (60.0 percent), flexor digitorum superficialis 2-5 (59 .2 percent), ulnar nerve (58.3 percent), and ulnar artery (56.7 percen t). A predilection for injury to the ulnar structures was observed. Th e flexor carpi ulnaris was more commonly injured than the more superfi cial central and radial palmaris longus (48.3 percent) and flexor carp i radialis (45.0 percent). The most common pattern of injury involved the ulnar nerve and artery and flexor carpi ulnaris, or so-called ulna r triad (41.7 percent). Combined median nerve, flexor carpi radialis, and palmaris longus lacerations occurred in 26.7 percent. Simultaneous lacerations of both median and ulnar nerves occurred in 23.3 percent. No distinct pattern of injury was noted in patients with simultaneous injury to both nerves. Simultaneous lacerations of both ulnar and rad ial arteries occurred in 6.7 percent; neither artery was injured in 33 .3 percent. In the subset of 19 patients available for follow-up exami nation, range of motion was excellent in 12 patients and good in 7 pat ients. In 12 patients with sufficient follow-up, intrinsic muscle reco very was good in 7 patients and fair to poor in 5 patients. Sensory re turn was disappointing: seven patients recovered only protective sensa tion and five patients demonstrated return of two-point discrimination that ranged from 7 to 12 mm in three patients and from 2 to 6 mm in t wo patients.