Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair

S. Dhanaraju, N. Kannan


Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.

Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.

Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.

Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor.



Diabetes mellitus, Smoking, Median nerve injury, Ulnar nerve injury

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Barrios C, Amarillo S, de Pablos J. Secondary repair of ulnar nerve injury: 44 cases followed for 2 years. Acta Orthop Scand. 1990;61(1):46-9.

Barrios C, de Pablos J. Surgical management of nerve injuries of the upper extremity in children: a 15-year survey. J Pediatr Orthop. 1991;11(5):641-5.

Birch R, Raji AR. Repair of the median and ulnar nerves. The primary suture is best. J Bone Joint Surg Br. 1991;73(1):154-7.

Calder JS, McAllister RM. Interpreting the results of unilateral digital nerve repair. J Hand Surg Br. 1993;18(6):797-9.

Deutinger M, Girsch W, Burggasser G. Peripheral nerve repair in the hand with and without motor sensory differentiation. J Hand Surg Am. 1993;18(3):426-32.

He B, Zhu QT, Chai YM. Outcomes with the use of human acellular nerve graft for repair of digital nerve defects: a prospective, multicenter, controlled clinical trial. J Tissue Eng Regen Med. 2012;6(1):76-9.

Inoue S, Ogino T, Tsuchida H. Digital nerve grafting using the terminal branch of posterior interosseous nerve: a report of three cases. Hand Surg. 2002;7(2):305-7.

Jaquet J, Kalmijn S, Kuypers P. Early psychological stress after forearm nerve injuries: a predictor for the long term functional outcome and return to productivity. Ann Plast Surg. 2002;49(1):82-90.

Kallio PK, Vastamäki M, Solonen KA. The results of secondary microsurgical repair of the radial nerve in 33 patients. J Hand Surg Br. 1993;18(3):320-2.

Lee YH, Shieh SJ. Secondary nerve reconstruction using vein conduit grafts for neglected digital nerve injuries. Microsurg. 2008;28(6):436-40.

Marcoccio I, Vigasio A. Muscle-in-vein nerve guide for secondary reconstruction in digital nerve lesions. J Hand Surg Am. 2010;35(9):1418-26.

Novak CB, Mackinnon SE, Kelly L. Correlation of two-point discrimination and hand function following median nerve injury. Ann Plast Surg. 1993;31(6):495-8.

Ruijs AC, Jaquet JB, Kalmijn S. Median and ulnar nerve injuries:a meta-analysis of predictors of the motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005;116(2):484-94.

Senes FM, Campus R, Becchetti F. Upper limb nerve injuries in developmental age. Microsurg. 2009;29(7):529-35.

Tang JB, Shi D, Zhou H. Vein conduits for repair of nerves with a prolonged gap or in unfavorable conditions: an analysis of three failed cases. Microsurg. 1995;16(3):133-7.