Ulnar Nerve Neurotization After Ulnar Nerve Injury

Study Overview
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Brief Summary
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This study will evaluate the hand intrinsic muscles functional recovery after distal neurotization of ulnar nerve

Detailed Description
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ulnar nerve injuries result in loss of both the sensory and motor elements within the hand. these injuries can be classified by the site of injury into low injuries and high injuries. In low ulnar nerve injuries, the nerve is injured distal to the motor branch of the Flexor carpi ulnaris (FCU) and motor branch to the Flexor digitorum profundus (FDP) of the ring and little fingers. In low injuries, sensation is lost in palmar ulnar hand and paralysis occurs usually to all 7 interossei, the ulnar 2 lumbrical, the 3 hypothenar, the adductor pollicis, and the deep head of the flexor pollicis brevis muscles . After peripheral nerve lesion axonal regeneration is at a rate of 1-2 mm/day. Because muscle fibers undergo irreversible changes after 12 months of denervation, it is important that treatment be undertaken as early as possible for successful functional recovery . Babysitting nerve fiber transfers can be defined as giving fibers from a healthy donor trunk to a denervated recipient trunk, in order to allow these fibers reach the distal effectors to avoid atrophy; such a procedure has originally been described together with partial neurotomy and has been found to be efficient both in experimental and clinical studies As far as it concerns proximal ulnar nerve injuries, babysitting by end-to-side nerve transfer has proven effective in 1 of the 3 series reported, where Colonna et al. analyzed an alternative Martin Grubertype( type of of operation) connection created by a bridge nerve graft between median (donor) and ulnar (recipient) trunks in the distal forearm, which gave interesting, but not ideal results ; supercharged reverse end-to side nerve transfers have been reported in latter studies . another person reported 7 cases of distal anterior interosseous to ulnar nerve end-to-end coaptation together with palmar cutaneous branch of the median nerve to the ulnar nerve above the wrist in a previous paper . it has not yet been well-established whether end-to-end or end-to-side gives better results. nowadays, surgeons performing this type of surgery complain inconsistent outcomes, maybe as an effect of the discrepancy between the number of fibers in donor nerves and those in the recipient one

Official Title
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Evaluation of Hand Intrinsic Muscles Functional Recovery After Distal Neurotization of Ulnar Nerve

Conditions
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Ulnar Nerve Injury

Intervention / Treatment
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* Procedure: End To End or End to side sutures


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Site of the injury: at or proximal to level of the elbow Nature of the injury; post traumatic injury. Sex; both males and females. Age; any age. Time of presentation of injury: less than 6 months from injury. Exclusion Criteria: Any patient with non-post traumatic injury either inflammatory or tumor caused palsy or idiopathic. Any distal injury below origin of FCU branch. Delayed presentation after 6 months of injury. Any patient refusing participation in this study.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ( group 1)<br>End to End sutures | Procedure: End To End or End to side sutures<br>* End to end or End to side sutures of ulnar nerve by nerve to quadratus muscle ( branch of anterior interosseous nerve )<br>|
| ( group 2 )<br>End to Side sutures | Procedure: End To End or End to side sutures<br>* End to end or End to side sutures of ulnar nerve by nerve to quadratus muscle ( branch of anterior interosseous nerve )<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| evaluate the hand intrinsic muscles functional recovery after distal neurotization of ulnar nerve | (1) Evaluation of hand intrinsic muscle functional recovery by : A- Muscle power by standard Medical Research Council (MRC) grading B- grip strength by dynamometer C- pinch strength will done based on grading of adductor pollicis muscle. D- Evaluation of clawing will done based on clinical observation E- DASH( Disabilities of the Arm, Shoulder and Hand ) score pre and post | 8 months |