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Comparison of Ulnar Intrinsic Function following Supercharged End-to-Side AIN Transfer to Ulnar Motor Nerve: A Matched Cohort of Study High Ulnar Nerve Injury Patients
Heather L. Baltzer, MD; Alice Woo, MD; Christine Oh, MD; Steven L. Moran, MD
Mayo Clinic, Rochester, MN

Purpose: To review our experience with high ulnar nerve injury patients that underwent a supercharged end-to-side anterior interosseous to ulnar motor nerve (SETS) transfer along with conventional surgical treatment. These patients were compared with a matched cohort of patients that did not have a SETS transfer to assess return of intrinsic function

Methods: A retrospective matched-cohort study identified all patients that underwent the SETS transfer between 2000-2014 and a second cohort of ulnar nerve injury patients that did not have the transfer, matched based on age, level and mechanism of injury (transection, compressive). The primary outcome was ulnar intrinsic function improvement, which included evidence of reinnervation on clinical examination and/or EMG. Dichotomous and continuous variables were compared with Fisher's exact and Student T-tests, respectively.

Results: Thirteen SETS patients with appropriate follow-up were identified. The average age at surgery for SETS patients and the matched cohort was 35 (+/- 14) and 35 (+/- 16) years, respectively. Transection of the ulnar nerve at or above the proximal third of the forearm represented 50% of patients, the remainder of injuries were compressive in nature. All patients presented with clinical or electrodiagnostic evidence of ulnar intrinsic denervation. Eleven SETS transfer patients (84%) had clinical evidence of recovery of intrinsic function compared with five (38%) of patients that did not have the SETS transfer (p<0.05). Following ulnar nerve transection, greater intrinsic function return was demonstrated following the SETS transfer (85%vs. 14%, p = 0.03), while compressive injuries had comparable intrinsic function return between groups (67%). Where documented, the average time to first evidence of recovery was 2.9 months (+/-1.4) and 3.8 months (+/- 4.5) with and without the SETS transfer, respectively (p > 0.05). Nerve transection repairs augmented with a SETS transfer demonstrated ulnar intrinsic recovery on average at 3.4 months (+/-1.7), while recovery occurred closer to a year or not at all with repair alone.

Conclusions: This matched cohort study demonstrates that the SETS transfer results in increased ulnar intrinsic reinnervation following high ulnar nerve injury. From both a frequency and timing of recovery standpoint, this finding appears to be most relevant among patients with transection compared to compressive type injuries.

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