MANAGEMENT AND RESULTS OF EXTENSIVE VOLAR WRIST LACERATIONS: “THE SPAGHETTI WRIST“ IN 124 PATIENTS DURING A 5 YEAR PERIOD IN 15TH KHORDAD HOSPITAL TEHRAN

 ABSTRACT Background: Spaghetti wrist is a sharp volar wrist laceration in which at least 10 structures, including tendons, at least one major nerve and usually one major vessel are divided. These injuries are usually accompanied with severe permanent complications. The aim of this study was to evaluate the spaghetti wrist injury in Iran and find ways to decrease complications and obtain better results. Methods: This study was done during a 5- year period between March 1999 and March 2003 in the Department of Plastic and Reconstructive Surgery of 15th Khordad Hospital, Shahid Beheshti University Medical School, Tehran, in the subset of 30 patients available for follow-up examination. Results: This study reviewed 124 patients with "spaghetti wrist" lacerations. All injuries were sharp lacerations. A total of 115 men and 9 women, average age 24.5 years (range 8 to 62 years) sustained spaghetti wrist injures. The most commonly injured hand was the right hand (74.9 percent). The most frequently injured tendons were third and fourth FDS (98.3 percent). The ulnar nerve was more commonly injured than the median nerve. The ulnar artery was more commonly injured than the radial artery. In the subset of 30 patients available for follow-up examination, range of motion was excellent in 14 patients and good in 8 patients. Intrinsic muscle recovery was good in 9 patients and fair to poor in 21 patients. Sensory return was disappointing: 17 patients recovered only protective sensation and 13 patients demonstrated return of two-point discrimination that ranged from 7 to 13 mm in 10 patients and from 2 to 6 mm in 3 patients. Conclusion: Generally recovery of function in "spaghetti wrist" after repair is not satisfactory. In order to obtain better results accurate repair of injured structures, early movement, appropriate physiotherapy and patient co-operation are required.