gms | German Medical Science

Objectives/Interrogation: Wrist denervation for the management of chronic wrist pain is already known as a safe and effective procedure. However there is no consensus on the performance of posterior interosseous nerve (PIN) neurectomy to reduce pain in acute trauma.

The aim of this paper was to evaluate the PIN neurectomy effectiveness in improving analgesia in the postoperative period, when used associated to the surgical treatment of some acute affection.

Methods: This is a double-blind study lasting from March 2017 to March 2018. Thirty cases of wrist acute trauma that required surgical treatment with dorsal approach to the wrist were selected at a orthopedic trauma hospital. However 10 patients were excluded because they did not completed the inclusion criteria, for example isolated injury in the wrist without previous lesions. It was included 20 patients presenting perilunate dislocation, trans-scaphoid perilunate fracture dislocation or transradial-styloid trans-scaphoid perilunate fracture dislocation. They were randomized into two groups: the first group (10 patients) received the surgical treatment of their pathology associated with PIN neurectomy and the second group (10 patients) received the treatment without the neurectomy. The patients' degree of pain was assessed through a numerical scale of pain (1 to 10) on the preoperative period, on the first postoperative day and on the first return visit. Fisher's Chi-square test and the Mann-Whitney test with 95% confidence interval and p value <0.05 were used.

Results and Conclusions: The ratio of male gender was 85% and median age was 35.9 years (+-14.36). The mean value of pain was 4.90, 2.85 and 1.85 on the preoperative period, on the first postoperative day and on the first return, respectively. The pathology with the highest degree of pain was transradial-styloid trans-scaphoid perilunate fracture dislocation (6.5, 4.5 and 3.0 respectively). The mean value of pain in the first group submitted to neurectomy was 4.50, 1.20 and 0.90 on the preoperative period, on the first postoperative day and on the first return, respectively. And the mean value of pain in the second group was 5.30, 4.50 and 2.80, respectively.

There was a statistically significant difference in the value of pain on the first postoperative day and on the first return (p = 0.01 and p = 0.04, respectively) among the two groups. The outcome showed that the association of the PIN neurectomy to the surgical treatment of acute affections reduced postoperative pain in the short and medium term.