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J Hand Microsurg 2023; 15(02): 098-105
DOI: 10.1055/s-0041-1734399
Review Article

Anterior Interosseous Nerve to Ulnar Nerve Transfers: A Systematic Review

Melanie D. Luikart
1   Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Justin M. Kistler
1   Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
2   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
,
David Kahan
1   Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
2   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
,
Richard McEntee
1   Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Asif M. Ilyas
1   Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
2   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding None.
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Abstract

Background There has been an increasing utilization of end-to-end (ETE) and reverse “supercharged” end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN–ulnar NT.

Methods A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council–graded motor strength. Comparisons were made using the independent t-test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied.

Results NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation.

Conclusion ETE and SETS AIN–ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT.

Keywords

anterior interosseous nerve - ulnar nerve - ulnar nerve injury - nerve transfer

Statement of Informed Consent

This study uses published data and requires no informed consent.


Statement of Human and Animal Rights

No experimentation or procedures were performed on animals or humans during this study.




Publication History

Article published online:
01 October 2021

© 2021. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery 2009; 65 (05) 966-977 , discussion 977–978
    Google Scholar
  • 2 Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand Clin 2008; 24 (04) 319-340
    CrossrefPubMedGoogle Scholar
  • 3 Sukegawa K, Kuniyoshi K, Suzuki T. et al. An anatomical study of transfer of the anterior interosseous nerve for the treatment of proximal ulnar nerve injuries. Bone Joint J 2014; 96-B (06) 789-794
    CrossrefPubMedGoogle Scholar
  • 4 Sammer DM, Chung KC. Tendon transfers: part II. Transfers for ulnar nerve palsy and median nerve palsy. Plast Reconstr Surg 2009; 124 (03) 212e-221e
    CrossrefPubMedGoogle Scholar
  • 5 Gaul Jr JS. Intrinsic motor recovery–a long-term study of ulnar nerve repair. J Hand Surg Am 1982; 7 (05) 502-508
    Google Scholar
  • 6 Battiston B, Lanzetta M. Reconstruction of high ulnar nerve lesions by distal double median to ulnar nerve transfer. J Hand Surg Am 1999; 24 (06) 1185-1191
    Google Scholar
  • 7 Li Q, Zhang P, Yin X, Jiang B. Early nerve protection with anterior interosseous nerve in modified end-to-side neurorrhaphy repairs high ulnar nerve injury: a hypothesis of a novel surgical technique. Artif Cells Nanomed Biotechnol 2015; 43 (02) 103-105
    CrossrefPubMedGoogle Scholar
  • 8 Vastamäki M, Kallio PK, Solonen KA. The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg [Br] 1993; 18 (03) 323-326
    CrossrefPubMedGoogle Scholar
  • 9 Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am 2010; 35 (02) 332-341
    CrossrefPubMedGoogle Scholar
  • 10 Barbour J, Yee A, Kahn LC, Mackinnon SE. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. J Hand Surg Am 2012; 37 (10) 2150-2159
    CrossrefPubMedGoogle Scholar
  • 11 Lee SK, Wolfe SW. Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg 2012; 20 (08) 506-517
    CrossrefPubMedGoogle Scholar
  • 12 Davidge KM, Yee A, Moore AM, Mackinnon SE. The supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer for restoring intrinsic function: clinical experience. Plast Reconstr Surg 2015; 136 (03) 344e-352e
    Google Scholar
  • 13 Flores LP. Comparative study of nerve grafting versus distal nerve transfer for treatment of proximal injuries of the ulnar nerve. J Reconstr Microsurg 2015; 31 (09) 647-653
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Baltzer H, Woo A, Oh C, Moran SL. Comparison of ulnar intrinsic function following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer: a matched cohort study of proximal ulnar nerve injury patients. Plast Reconstr Surg 2016; 138 (06) 1264-1272
    CrossrefPubMedGoogle Scholar
  • 15 Sallam AA, El-Deeb MS, Imam MA. Nerve transfer versus nerve graft for reconstruction of high ulnar nerve injuries. J Hand Surg Am 2017; 42 (04) 265-273
    CrossrefPubMedGoogle Scholar
  • 16 Zhu S, Liu J, Zheng C. et al. Analysis of human acellular nerve allograft reconstruction of 64 injured nerves in the hand and upper extremity: a 3 year follow-up study. J Tissue Eng Regen Med 2017; 11 (08) 2314-2322
    CrossrefPubMedGoogle Scholar
  • 17 Jarvie G, Hupin-Debeurme M, Glaris Z, Daneshvar P. Supercharge end-to-side anterior interosseous nerve to ulnar motor nerve transfer for severe ulnar neuropathy: two cases suggesting recovery secondary to nerve transfer. J Orthop Case Rep 2018; 8 (05) 25-28
    CrossrefPubMedGoogle Scholar
  • 18 Domeshek LF, Novak CB, Patterson JMM. et al. Nerve transfers-a paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open 2019; 7 (06) e2290
    CrossrefPubMedGoogle Scholar
  • 19 Novak CB, Mackinnon SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 2002; 18 (06) 459-464
    Google Scholar
  • 20 Delclaux S, Aprédoaei C, Mansat P, Rongières M, Bonnevialle P. Case report: Double nerve transfer of the anterior and posterior interosseous nerves to treat a high ulnar nerve defect at the elbow. Chir Main 2014; 33 (05) 320-324
    CrossrefPubMedGoogle Scholar
  • 21 Head LK, Zhang ZZ, Hicks K, Wolff G, Boyd KU. Evaluation of intrinsic hand musculature reinnervation following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. Plast Reconstr Surg 2020; 146 (01) 128-132
    CrossrefPubMedGoogle Scholar
  • 22 Doherty CD, Miller TA, Larocerie-Salgado J, Byers BA, Ross DC. Reverse end-to-side anterior interosseous nerve-to-ulnar motor transfer for severe ulnar neuropathy. Plast Reconstr Surg 2020; 146 (03) 306e-313e
    CrossrefPubMedGoogle Scholar