Spaghetti wrist injuries involve laceration of some or all of the volar structures at the wrist, including the 12 wrist and digital flexor tendons, median and ulnar nerves, and the radial and ulnar arteries. Few long-term reports of functional outcomes have been published. Several small series have included small cohort sizes. This study is a long-term functional outcome evaluation of a large group of patients treated for spaghetti wrist injuries over an 18-year period at a single center. Mean follow-up was 10 years from injury. The authors compared outcomes for two definitions of spaghetti wrist: 1) laceration of both nerves with flexor tendons, and 2) laceration of at least 10 structures including the median and/or ulnar nerves. Examination by independent physicians not involved in the patients treatment included motor and sensory recovery. Questionnaires were sent to participants, evaluating DASH scores, return to work status, and Impact of Event Scale scores to determine psychological impact.
Forty-three patients participated fully in the evaluations. Overall, the group reported significant residual symptoms at 10 years, with mean Functional Symptom Score of 15. 94% of the patients lost time from work, and 45% had not returned to work at one year after the injury. Significant psychological impact was noted at one month after the injury, with a mean Impact of Event score of 26/100. No patients regained normal sensation. Most achieved diminished or absent protective sensation, and 7/43 did not regain any sensation at all. Significant intrinsic loss was noted in most patients. Mean loss of grip and pinch strength was 24% and 34%, respectively.
The authors showed that spaghetti wrist injuries have a significant and long-lasting impact on functional outcome parameters, return to work, and psychological stress, even at 10 years following treatment. There were no statistically significant differences in the measured parameters for the two definitions of spaghetti wrist, except in sensory recovery. This study shows the long-lasting nature of both functional and psychosocial consequences of these devastating injuries. This should guide our counseling with patients and their families to better prepare them for the difficult recovery and permanent impact on their lives.
Plastic & Reconstructive Surgery