Zancolli procedure and nerve repair with sural graft as a treatment for patient with claw hand due to complete rupture of ulnar and median nerve: A case report

INTRODUCTION: Combined injuries of peripheral nerve of upper extremity are usually the result of severe trauma to the extremity, and are often associated with substantial soft tissue, vascular, and bony injuries. The most common form of such combined injury is a low median-ulnar palsy, usually due to laceration of the volar wrist. It is a devastating injury, and with delayed presentation the injury is going to be more difficult to reconstruct. PRESENTATION OF CASE: Ten-year-old girl was admitted to hospital with numbness of her left palm and fingers, 5 months before admission. She was hit by a car while riding a bicycle from opposite direction from she was heading and cut her left forearm by licensed plate. Initially treated at nearby clinic but later couldn’t extend her fingers after the pain subsided and left untreated for 5 months. DISCUSSION: Traditionally, number of static procedures have been described to correct the claw hand deformity by preventing MCP joint hyperextension. Nevertheless, these procedures are reserved for those having ability to extend IP joints while MCP joint hyperextension were prevented. Conversely, static procedure like Zancolli capsulodesis is simple and do not sacrifice any motors in an already compromised extremity. Combined with sural graft, the outcome for the patient is hopefully better than Zancolli procedure alone. CONCLUSION: Zancolli procedure along with nerve repair with sural graft as a treatment of claw hand due to complete rupture of ulnar and median nerve is one of feasible treatment options to correct claw hand deformity with such combined palsy.