Manara - Qatar Research Repository
Browse

Ulnar Nerve Injury during Treatment of Fourth and Fifth Metacarpal Fractures: A Case Report and Anatomical Review

Download (838.64 kB)
journal contribution
submitted on 2024-02-12, 05:44 and posted on 2024-02-12, 05:45 authored by Mohammed Muneer, Yahya Alborno

Summary:

The deep branch of the ulnar nerve (DBUN) is a pure motor nerve. It passes through a hypothenar fibromuscular tunnel and courses radially on the interossei surface. The DBUN is not frequently considered during hand fracture surgery, despite the anatomical course of the nerve in close relation to the carpal and metacarpal bones, which makes it vulnerable to penetrating injury and being injured during hand surgery fixations. In this article, we describe a case of DBUN injury after percutaneous pinning of the fourth and fifth metacarpal bone fractures complicated by intrinsic muscle wasting of the hand that was treated with neuroma excision and sural nerve graft. We present the case of a 36-year-old man, who had a fracture of the base of the fourth and fifth metacarpal bones, which was treated with multiple K-wires. A few months later, the patient presented with weak abduction/adduction of the three ulnar fingers and prominent wasting in the intrinsic muscles of the hand. On hand exploration, a 2-cm neuroma was found along the course of the DBUN distal to the hypothenar fibromuscular tunnel, which was treated by neuroma excision and nerve grafting. Fractures of the fourth and fifth metacarpals and carpometacarpal dislocations are very common and are often treated surgically. To fix these fractures, awareness of the DBUN course in the hand and its proximity to the carpal and metacarpal bones is important. High caution should be taken during percutaneous pinning by inserting K-wires under radiological guidance, minimizing pining attempts and limiting pin tip protrusion to 1–2 mm.

Other Information

Published in: Plastic and Reconstructive Surgery - Global Open
License: http://creativecommons.org/licenses/by-nc-nd/4.0/
See article on publisher's website: https://dx.doi.org/10.1097/gox.0000000000004979

Funding

Open Access funding provided by the Qatar National Library.

History

Language

  • English

Publisher

Wolters Kluwer

Publication Year

  • 2023

License statement

This Item is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Institution affiliated with

  • Hamad Medical Corporation

Usage metrics

    Hamad Medical Corporation

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC