Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?

Abstract

Objectives: This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand the term “spaghetti” from the wrist to forearm in such terrifying cases.

Patients and methods: Data from a total of 50 patients (44 males, 6 females; mean age: 48.5±25.7 years; range, 10 to 70 years) who were treated for multicomponent soft tissue injuries of the wrist and forearm, including at least one major artery and one major nerve, between February 2020 and December 2021 were retrospectively analyzed. The patients were divided into the wrist injury group (n=30) and forearm injury group (n=20) according to the location of laceration. Demographic characteristics, including age, sex ratio and mechanism and side of injury, total lacerated structures, and outcomes, including tendon function, opposition, intrinsic muscle function, deformities, sensation and grip strength were evaluated.

Results: In the wrist injury group, a mean of 12.27±3.53 structures at the volar side were injured. It took a mean time of 1.8±0.4 h for emergency surgical repair and, after a mean of 16.6±5.3 month follow-up, most patients received excellent/good outcomes in the six aspects. In the forearm injury group, a mean of 12.95±2.96 structures at the volar side were injured. It took an average time of 2.1±0.4 h for emergency surgical repair and, after a mean of 15.4±6.4 month follow-up, most patients received excellent/good outcomes and were satisfied with the functional recovery. Only surgical time (p=0.018) and final grip strength (p=0.023) between the two groups showed a statistically significant difference.

Conclusion: We propose to merge the severe wrist and proximal forearm laceration of multiple tendons/muscles with at least one major artery and one major nerve as a whole, namely the spaghettiketchup injury, since the laceration of wrist and that of proximal forearm in this study share similar mechanisms and outcomes after primary repair or reconstruction.

Citation: Wang F, Zhang R, Liu S, Ruan H, Xu J, Kang Q. Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?. Jt Dis Relat Surg 2022;33(2):273-284.

* Co-First Author

Ethical approval of the study was obtained from Institutional Ethics Committee of Shanghai Sixth People’s Hospital (2021-KY-113(K)). The study was conducted in accordance with the principles of the Declaration of Helsinki.

A written informed consent was obtained from each patient.
Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Manuscript drafting; F.W., R.Z.; Data collection: S.L.; Data analysis: H.R.; Study design: J.X., Q.K.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Received financial support from National Natural Science Foundation of China (No. 82072421) and Natural Science Foundation of Shanghai (No.20ZR1442200).