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

Document Type : RESEARCH PAPER

Authors

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

10.22038/abjs.2024.83645.3806

Abstract

Objectives: High ulnar nerve injuries often cause severe functional impairment, and the best secondary 
repair method remains debated. This study compared the effectiveness of sural nerve grafting and 
anterior interosseous nerve (AIN) transfer following failed primary ulnar nerve repairs .
Methods: This retrospective cohort study included 42 patients with isolated high ulnar nerve injuries who required 
secondary surgical intervention. Patients were allocated to either 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. 
Results: The AIN transfer group exhibited significantly superior motor recovery, with 68.5% of patients achieving 
BMRC grades M4–M5, compared to only 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). 
Conclusion: AIN transfer provides superior outcomes compared to sural nerve grafting for the secondary repair of 
high ulnar nerve injuries, demonstrating significantly enhanced motor and sensory recovery, grip and pinch strength, 
and overall functional improvement. 
 Level of evidence: III

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 13, Issue 6
June 2025
Pages 349-358

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History

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

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