Introduction: Among various patterns of complex injuries of the wrist
and forearm, “spaghetti wrist” refers to an extensive volar forearm
laceration, in which several of the 12 tendons, 2 major nerves and 2
major arteries are transected, leading to lifelong disability and
psychological, social and economic consequences. The aim of the study is
to emphasize the keynote principles for the management of these injuries
through retrospective review of a large group of patients treated by a
team of experienced hand surgeons.
Material-Methods: Data were retrospectively obtained for 61 patients (49
males and 12 females with average age of 34.7 years) treated for
spaghetti wrist lacerations and followed for a minimum period of two
years, in two accredited Orthopaedic / Hand-Upper Extremity Surgery and
Microsurgery Departments in Greece. All patients were treated within 16
hours of injury and underwent primary, layered reconstruction of all
injured structures through an axial forearm exposure.
Results: The most frequent mechanism of injury was glass-related
lacerations. Overall, 541 structures were reconstructed, of which 417
were tendons, 76 nerves, and 48 arteries. An average of 8.86 structures
were injured per patient, including 6.83 tendons, 1.24 nerves, and 0.79
arteries. The majority of the patients (28/61) had >= 10 structures
injured (45.9%), while 32.7% (20/61) and 21.3% (13/61) of patients
had 6-9 and 3-5 injured structures respectively. Almost 80% (49/61) of
patients had excellent/good grading in all six tests used for the
functional assessment post-operatively.
Discussion: Spaghetti wrist injuries usually occur in a transverse wound
pattern and necessitate timely and definitive operative reconstruction
of all injured structures in layers, through an axial approach, by
experienced hand surgeons to maximize outcome and to avoid
complications. The most important prognostic factor of functional
recovery is not the number of transected tendons, but the involvement of
ulnar and/or median nerve injury. (C) 2021 Elsevier Ltd. All rights
reserved