Secondary Ulnar Nerve Reconstruction of High Ulnar Nerve Injuries: A Comparative Study of Sural Grafting and Anterior Interosseous Nerve Transfer

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

10.22038/abjs.2024.83645.3806

Abstract

Objectives: High ulnar nerve injury often leads to significant functional impairment, and the optimal secondary repair technique remains controversial. This study compared the efficacy of sural nerve grafting and anterior interosseous nerve (AIN) transfer in restoring function after failed primary ulnar nerve repairs.

Methods: This retrospective cohort study included 42 patients with isolated high ulnar nerve injuries who required secondary surgical intervention at a tertiary care university hospital between January 2020 and March 2024. Patients were allocated to the sural nerve grafting (n = 23) or AIN transfer (n = 19) group based on predefined clinical criteria. Motor and sensory functions were assessed using the British Medical Research Council (BMRC) grading system and a two-point discrimination (2PD) test. Grip and pinch strength were measured, and functional recovery was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Outcomes were assessed at regular intervals for up to 24 months postoperatively.

Results: The AIN transfer group exhibited significantly superior motor recovery, with 68.5% achieving BMRC grades M4–M5 compared to 17.4% in the sural grafting group (P = 0.03). Sensory recovery was also markedly better in the AIN group, with a higher proportion of patients reaching BMRC sensory grades S3–S4 (P = 0.04). Additionally, the AIN transfer group demonstrated significantly greater grip strength (30.1 ± 6.1 kg vs. 24.3 ± 5.2 kg; P = 0.03) and pinch strength (7.2 ± 1.5 kg vs. 5.8 ± 1.3 kg; P = 0.04). Improvement in DASH scores was more substantial in the AIN group (–26.6 ± 5.7 vs. –14.6 ± 4.3; P = 0.02), indicating better functional recovery. Although the AIN group showed a trend toward improved 2PD, the difference was not statistically significant (P = 0.18). No major complications were reported in either group of patients.

Conclusions: AIN transfer provides superior outcomes compared to sural nerve grafting for secondary repair of high ulnar nerve injuries, demonstrating significantly better motor and sensory recovery, grip and pinch strength, and functional improvement. These findings underscore the preference of nerve transfer techniques for high ulnar nerve reconstruction.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 22 April 2025

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History

  • Receive Date: 27 October 2024
  • Revise Date: 25 November 2024
  • Accept Date: 21 December 2024

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