Primary repair of the severe “spaghetti wrist” with good functional outcome measured using quick dash scoring system: Management from LMIC perspective

INTRODUCTION AND IMPORTANCE: Spaghetti wrist as a part of occupational injury is common among the young adults. Involvement of the multiple neurovascular structures and tendons at wrist may severely impact the quality of life. But if timely intervention can be undertaken the prognosis can be modified with good functional outcome. Moreover the need for common consensus for the appropriate management protocols of such severe traumatic injuries is utmost. CASE PRESENTATION: A 29 years old working male sustained severe cut injury at volar aspect of wrist from glass involving multiple tendons and neurovascular structure as a part of occupational injury. Patient was rushed within 1 h to the nearest tertiary care center and further within 2 h emergency reconstructive surgery was carried out with primary repair of ten tendons, one nerve and one artery. At 9 months follow up patient had satisfactory sensory and motor functional outcome and further at 10 month follow up Qucik Dash scoring system for measuring functional outcome showed significant score suggestive of good functional outcome. CLINICAL DISCUSSION: Spaghetti wrist being one of the grievous hand injuries requiring immediate surgical intervention. The involvement of multiple neurovascular structures and tendons might result in poor functional outcome if there is delay in proper management. Despite absence of adequate guidelines in treatment of such occupational injuries immediate primary repair can be also a significant modality of management. CONCLUSION: Spaghetti wrist being severe traumatic injury without any common consensus for proper management, despite this timely intervention with only primary repair have shown good functional outcome with enhanced quality of life.