Early phase tendon transfers in radial and ulnar nerve injuries: internal splinting

Abstract

Objectives: Internal splinting is defined as early tendon transfer performed during or just after nerve repair follow­ing nerve injury and is a controversial issue. The objec­tives of internal splinting are avoiding the use of long term external splinting, avoiding permanent hand deformities until the injured nerve is reinnervated and supporting sensorial recovery. In this paper we present our clinical cases of internal splinting and discuss the results in terms of indications, timing, advantages, and disadvantages of internal splinting. Materials and Methods: We applied internal splinting in 11 patients, 3 patients with radial nerve injury and 8 patients with ulnar nerve injury. Internal splinting was performed contemporarily with the nerve repair in 5 pa­tients, in 2 weeks following nerve repair in 1 patient and in 4 weeks following nerve repair in 5 patients. Pronator teres was transferred to extensor carpi radialis brevis and flexor carpi radialis was transferred to extensor digitorum communis in radial nerve injuries. Omer\'s superficial Y technique and its modification were used for ulnar nerve injuries. Results: Patients were followed up for at least 1 year with physical examination and electroneuromyelography and recovery of sensorial and motor functions were achieved in all of them. Conclusion: We concluded that internal splinting is use­ful for avoiding external splint usage and preventing the establishment of hand deformity until recovery of the nerve. The contribution of internal splinting to sensorial recovery was noteworthy as stated in the literature but the lack of control group and the small number of our cases was limited to come to a definite conclusion. We did not experience any disadvantage of internal splinting.

Keywords

• radial nerve, ulnar nerve, internal splint, ten­don transfer.

Radial ve ulnar sinir yaralanmalarında erken dönem tendon transferleri: internal splintleme

Abstract

Amaç: İnternal splintleme sinir hasarı olan hastalarda si­nirin rejenere olmasını beklemeden yapılan erken tendon transferleridir ve literatürde tartışmalı bir konudur. İnter­nal splintlemenin amacı hastaya atel kullandırmamak, si­nir iyileşene kadar gelişebilecek olan kalıcı deformiteleri engellemek ve duyu restorasyonuna destek olmaktır. Bu yazıda internal splintleme yaptığımız olguları sunduk ve elde edilen sonuçları internal splintlemenin endikasyon­ları, zamanlaması, avantaj ve dezavantajları yönünden derledik. Gereç ve Yöntem: Bu çalışmada 3\'ü radial sinir ve 8\'i ulnar sinir hasarı olan toplam 11 hastaya internal splint uygulandı. İnternal splintleme 5 hastada sinir onarımı ile eş zamanlı, 1 hastada 2. haftada, 5 hastada 4. haftada gerçekleştirildi. Radial sinir hasarlarında pronator teres ekstensör karpi radialis brevis\'e ve fleksör karpi radialis ekstensör digitorum kommunis\'e transfer edildi. Ulnar si­nir hasarı olan hastalara Omer\'in yüzeyel Y tekniği ve bu tekniğin modifikasyonu uygulandı. Bulgular: Hastalar en az 1 yıl boyunca fizik muayene ve ENMG ile takip edildi ve tümünde duyu ve motor fonksi­yon tam olarak restore edildi. Sonuç: İnternal splintlemenin atel kullanımını engellediği ve yukarı seviyede olan sinir yaralanmalarında sinir iyile­şene kadar el deformitesinin oluşumunu engellediği için yararlı olduğu sonucuna vardık. Literatürde belirtildiği gibi internal splintlemenin duyu restorasyonuna olan katkıları bizim çalışmamızda da dikkat çekici idi ancak olgu sayı­sının az olması ve kontrol grubunun olmaması kesin bir yargıya varmayı sınırladı. İnternal splintlemenin herhangi bir dezavantajı ile karşılaşılmadı.

Keywords

• Radial sinir, ulnar sinir, internal splint, tendon transferi.

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