Functional Outcome of Anterior Interosseous Nerve Transfer to The Motor Branch of The Ulnar Nerve for High Ulnar Nerve Injuries
Objective: To evaluate functional outcome of the anterior interosseous nerve transfer to the motor branch of the ulnar nerve for cases of high ulnar nerve injuries
Methods: This descriptive study was conducted in Hand and Upper Limb Surgery (HULS) CMH Lahore Medical College Pakistan from 21st July 2016 to 21st August 2018. A total of 13 patients (10 males, 03 females), mean age 32years(range 18 to 42) with injury to the ulnar nerve(high) were treated with anterior interosseous nerve(AIN) transfer to the motor branch of ulnar nerve. Functional outcome was evaluated clinically preoperatively, immediately postoperatively and 03 to 06 month follow up to evaluate motor functional grading system.
Results: In high ulnar nerve injury in whom anterior interosseous nerve was transferred all cases showed good outcomes (M3 to M4 by motor functional grading system) with mean initial recovery period of 3.5 months
Conclusion: Treatment of high ulnar nerve injury with transfer of the anterior interosseous nerve to the motor branch of the ulnar nerve results in early near normal intrinsic recovery and restoration of hand functions.
2. Mumenthaler M, Schliack H. Peripheral nerve lesions. New York: Thieme Medical Publishers, 1991.
3. Kirklin JW, Murphy F, Berkson J. Suture of peripheral nerves. Factors affecting prognosis. Surg Gynecol Obstet 1949;88:719-730.
4. Roganovic Z. Missile-caused ulnar nerve injury: outcomes of 128 repairs. Neurosurgery 2004;55:1120-1229
5. Secer HI, Daneyemez M, Gonul E, Izci Y. Surgical repair of ulnar nerve le - sions caused by gunshots and shrapnel: results in 407 lesions. J Neurosurg 2007;107:776-783
6. Kato H, Minami A, Kobayashi M, Takahara M, Ogino T. Functional results of low median and ulnar nerve repair with intraneural fascicular dissec - tion and electrical fascicular orientation. J Hand Surg Am 1998;23:471-482
7. Jaquet JB, Luijsterburg AJ, Kalmijn S, Kuypers PD, Hofman A, Hovius SE . Median, ulnar and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma 2001;51:687-692
8. Taha A, Taha J. Results of suture of radial, median and ulnar nerves after missile injuries below the axila. J Trauma 1998;45:335-339.
9. Pfaeffle HJ, Waitayawinyu T, Trumble TE. Ulnar nerve laceration and repair. Hand Clinic 2007;23:291-299
10. Haase S, Chung KC. Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries. Ann Plast Surg 2002;49:285-290
11. Novak CB, Mackinnom SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstruct Microsurg 2002;18:459-463
12. Battiston B, Lanzetta M. Reconstruction of high ulnar nerve lesions by distal double median to ulnar nerve transfer. J Hand Surg Am 1999;24:1185-1191.
13. Vastamaki M, Kallio PK, Solonen KA. The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg Br 1993;18:323-326
14. Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SE. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 2005;116:484-494.
15. Wang Y, Zu S. Transfer of a branch of the anterior interosseous nerve to the motor branch of the median and ulnar nerve. Chin Med J 1997;110:216-219
16. Brown JM, Yee A, Mackinnom SE. Distal median to ulnar nerve transfer to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery 2009;65:966-978
17. Schmidhammer R, Redl H, Hopf R, van der Nest DG, Millesi H. Synergistic terminal motor end-to-side nerve graft repair: investigation in a non-human primate model. Acta Neurochir 2007;100(Suppl):S97-S101
18. Pienaar C, Swan MC, de Jager W, Solomons M. Clinical experience with end-to-side nerve transfer. J Hand Surg Br 2004;29:438-443
19. Bertelli JA, Guizoni MF. Nerve repair by end-to-side cooptation or fascicular transfer: a clinical study. J Reconstruct Microsurg 2003;19:313-318