American Society for Peripheral Nerve

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Return to work for double and isolated major nerve injuries in volar forearm lacerations
Ryan B Bucknam, MD; Gilberto Agustin Gonzalez Trevizo, MD; Isaac Fernandez, BS
Texas Tech University Health Sciences Center El Paso, El Paso, TX

INTRODUCTION: Several studies have evaluated different aspects of recovery after lacerations to the volar forearm that involve damage to multiple tendons, nerves, and vascular structures. However, few studies have evaluated the difference in functional outcomes and return to work in patients who sustain injuries to two major nerves versus one major nerve. The purpose of this study is to determine the differences in functional scores and return to work (RTW) between patients who sustain injury to a single major nerve versus an injury to two major nerves.

METHODS: A retrospective review of patients who were treated for acute, partial or complete nerve injuries after volar forearm lacerations between January 2015 and December 2016 was conducted. All nerve repairs were performed by the same surgeon within 6-48 hours after the injury, using tension-free epineural, end to end coaptation with protective nerve conduits. Each patient followed the same rehabilitation protocol and had at least 12 months of follow up. Primary outcome measures included hand strength (lbs), QuickDASH scores, and RTW. QuickDASH and hand strength scores were compared using Mann-Whitney U tests, while Pearson Chi-Square tests were used to compare hand dominance and RTW using an a=0.05.

RESULTS: Twenty-seven patients had isolated ulnar nerve injuries (UNI), 22 had isolated median nerve injuries (MNI), and 12 had combined nerve injuries (CNI). All three groups were similar in terms of age, gender, and occupation. 11% of UNI, 23% of MNI, and 67% of CNI patients experienced injury to their non-dominant extremity (p=.0012). There were no significant differences between the two isolated nerve groups in terms of hand dominance (p=.5067) and functional scores (p=.2844) and strength scores (p=.8598) at 6 or 12 months. By 6 months, 89% of UNI and 95% of MNI had RTW (p=.5067). Patients with a UNI or MNI had overall better results at 12 months compared to patients with CNI in terms of QuickDASH scores (p<.0001), grip strength (p=.0163), and MRC scores (p=.0164). One year after the surgery, 12% of the UNI group, 4% of the MNI group, and 27% of CNI group did not RTW (p=.0185).

CONCLUSION: There appears to be no difference in functional recuperation after UNI and MNI in the forearm when treated according to the same protocol. The number of nerves affected and other social factors may affect the recovery of patients.

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