Spaghetti Wrist Injury: Past, Present, and Future

Abstract

This study will present our experience in treating “spaghetti wrist,” a complex injury of the distal forearm, with laceration of tendons, nerve(s), artery(es), and soft tissues. Also, we will present a review of the literature summarizing preoperative preparations, surgical and rehabilitation therapy, and immediate and delayed postoperative outcomes. The patients had complex injuries located in the distal 1/3 of the forearm, regardless of the physical etiologic agent, encompassing breach of the deep antebrachial fascia, at least one nerve, tendons, and, in some cases, arteries, along with single or multiple skin lacerations. The surgical procedure included surgical debridement, fasciotomy, decompression incisions, neurorrhaphy, tenorrhaphy, arteriorrhaphy, and soft tissue coverage protected by active/passive drainage. Depending on the anatomical structures reconstructed, the rehabilitation protocol was personalized, initially with dorsal immobilization in a plaster cast, followed by, as early as possible, passive and then active mobilization, under a single hand therapist’s control. Following prompt surgical intervention and adjusted personalized rehabilitation protocol, the results of even this type of challenging cases can be successful. The earlier the rehabilitation protocol was initiated, the better the results were. Patient adherence to the complex algorithm of treatment was also one of the most important prognostic aspects. What happens after the healing is another important aspect because the most devastating chronic complications, nervous deficits, must be evaluated and treated using modern possibilities.