Repair Versus AIN SETS in Ulnar Nerve Injuries: Cohort Study
Jordan Carter, BS, Texas Tech University Health Sciences Center, El Paso, TX, Michael M Polmear, MD, MS, Texas Tech University Health Sciences Center, EL Paso, TX, Fernando Herrera, MD, Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC, John Dunn, MD, Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX and Gilberto Gonzalez, MD, Texas Tech University Health Science Center. El Paso, Tx, El Paso, TX
The purpose of this study was to evaluate the clinical differences between primary ulnar nerve repair and primary repair plus ulnar nerve and anterior interosseous nerve (AIN) supercharged end-to-side (SETS) coaptation for proximal ulnar nerve injuries.
A retrospective review of prospectively collected data on 60 patients, including 28 undergoing primary ulnar nerve repair and 32 undergoing ulnar nerve AIN SETS coaptation. Only patients with isolated ulnar nerve injuries and no associated vascular injury were included in analysis. Patients were randomly assigned and all surgeries were performed 6-36 hours from the time of injury by the same surgeon at a single academic institution. Data collected included demographics, hand dominance, etiology, qDASH, MRC scale, grip strength, pinch strength, two-point discrimination, cold intolerance, and pain scores at 6 and 12 months post-operatively.
Of the 60 patients reviewed, most injuries were to the dominant hand (65%) in males (77%). Etiologies were either glass lacerations (88.3%) or knife wounds (11.7%). There was no difference in demographic variables between the two treatment groups. The average qDASH in the primary repair and ulnar nerve AIN SETS coaptation groups were 65.0 ± 5.5 and 45.9 ± 3.7 at 6 months (p<0.001) and 35.8 ± 4.4 and 24 ± 3.1 at 12 months, respectively. Ulnar nerve AIN SETS coaptation demonstrated superior MRC with odds ratios of M≥3 of 2.31 (95% CI 1.24 - 4.3) at 6 months and 1.91 (95% CI 0.89 - 4.09) at 12 months. Average grip strength in the primary repair and ulnar nerve AIN SETS coaptation groups were 46.4 ± 10.5 and 61.5 ± 19.5 lbs at 6 months and 74.8 ± 16.8 and 93.9 ± 25.9 lbs at 12 months, respectively. Average pinch strength in the primary repair and ulnar nerve AIN SETS coaptation groups were 6.75 ± 1.4 and 10.5 ± 2.6 lbs at 6 months and 11.9 ± 3.1 and 14.4 ± 3.8 lbs at 12 months, respectively. Two-point discrimination was significantly more sensitive in the AIN SETS coaptation group at 12 months with 100% of patients have ≤6mm discrimination. Cold intolerance was significantly better in the AIN SETS coaptation group at 12 months with 97% of patients denying cold intolerance. Pain scores were similar between the two groups.
Ulnar nerve primary repair plus AIN SETS coaptation yielded superior strength and improved upper extremity function following a proximal ulnar nerve injury compared to primary repair alone.
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