Reliability of deep branch of ulnar nerve identification in interosseous-to-ulnar motor nerve transfer: A cadaver study of 20 wrists.

Reinnervation of the intrinsic hand muscles after proximal ulnar nerve repair is often unsatisfactory. Promising results have nevertheless been reported recently for supercharged end-to-side anterior interosseous to deep branch of the ulnar nerve (DBUN) transfer. The aim of this study was to determine whether the DBUN can be reliably identified without retrograde intraneural dissection from Guyon's canal. Twenty cadaveric wrists were dissected. In a first stage, nerve transfer was performed through a limited 4 cm incision without releasing Guyon's canal. In a second stage, correct identification of the DBUN was assessed by retrograde intraneural dissection from its point of exit from Guyon's canal. The DBUN was correctly identified in 18 of the 20 wrists (90%). Although anatomical landmarks provide valuable clues, identifying the DBUN by neurolysis is technically challenging. All the elements required for nerve transfer can be exposed through a 4 cm incision, but the DBUN was nevertheless incorrectly identified in 10% of cases. Guyon canal release seems advisable to guarantee correct DBUN identification.

Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: Clinical results of a new technique using an endoscopic carpal tunnel release device.

Exertional compartment syndrome of the forearm is a rare pathology, occurring almost exclusively in motorcycle racers. The results of endoscopic techniques are similar to those of open fasciotomies, but they are less invasive and leave smaller scars. The aim of our study was to present a new endoscopic technique for superficial fasciotomy using the Agee® system and to describe the results. This was a single-center, retrospective descriptive study of 21 patients (36 forearms) operated on between 2006 and 2016. All patients but one were competitive motorcycle racers. The mean operating time was 38.2min (standard deviation (SD), 10.5min). The QuickDASH score was 23.3±10.2% preoperatively versus 1±2% postoperatively (mean±SD). Among the 18 patients who came back for a follow-up visit after 4.9±2.7 years, 17 (94%) were satisfied or very satisfied. The mean time before returning to sport was 4.3 weeks (SD, 1.8 weeks), 9 patients (50%) at the same level as before surgery, 8 (44%) at a higher level, and one at a lower level. There were a few minor complications (superficial vascular lesions, hematoma, transitory hypoesthesia) and symptoms recurred in two patients. Our technique yields outcomes similar to those of other published endoscopic procedures and allows early return to sport. It has the advantage of being based on the Agee endoscope, which is commonly used to treat carpal tunnel syndrome, making the procedure easy to master.