The Spaghetti Wrist Injuries: Presentation and Treatment

Abstract

Background: Spaghetti wrist injuries are devastating and may lead to permanent disability. The outcome of the repairs depends on how early the repair is undertaking.
Patient and Method: This is a review of spaghetti wrist injuries that were managed by our unit from June 2004 to September 2012. The information that were obtained from the operation register and case notes included demographic data, aetiology, time of presentation, mechanism of injury, affected limb, type of laceration, number and pattern of structure lacerated and type of repair.
Results: Nine patients were managed; five males and four females. Their age ranged from 11 years to 42 years. Five of them sustained machete injury from assault and the rest from glass cut. The left wrist was involved in five patients and the right in the other four. All assault injuries involved the left wrist except in one. Six of the patients had primary repair while the rest had secondary repair. The most common injured structures were the ulnar nerve and artery which occurred in all patients followed by the median nerve. A total of 101 structures (average of 11.2) were transected the highest being the tendons (8.3) followed by nerves (1.9) and arteries (1). Injury to the ulnar triad of ulnar artery, ulnar nerve and flexor carpi ulnaris occur more frequently (88.9%) than the radial triad (33.3%) of the median nerve, flexor carpi radialis and Palmaris longus that are more central and close to the radial side of the wrist.
Conclusion: Early presentation and repair of spaghetti wrist injury gives a better outcome. However, late presentations do occur which is still amenable to secondary repair.

Key words: Spaghetti wrist, flexor tendons, ulnar nerve, median nerve, early repair, secondary repair