الفهرس 
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Abstract
Nerve injuries in the upper extremity can cause permanent impairment and have devastating consequences. Direct primary repair should be performed if possible and appropriate for the mechanism of injury. Large nerve gaps, proximal injuries, and avulsion-type injuries prohibit direct repair and mandate secondary nerve reconstruction after the patient has recovered from the acute injury. Time constraints due to muscle atrophy after denervation and degeneration of the neuromuscular junction adversely influence the outcome.
Nerve transfers offer a surgical alternative for restoration of function by providing expendable axons close to the end organ and thereby minimizing the time required for reinnervation.
Thus, this study was carried out as a prospective study assessing the functional outcome of microsurgical peripheral nerve repair by nerve transfer for restoration of good and satisfactory function in patients with upper extremity peripheral nerve injuries.
The study was conducted on 46 patients attending the out-patient clinic of Orthopedic Department in Suez Canal University Hospital and followed up post-operatively for at least from 12 to 18 months.
According to type of affected nerve, 18 patients (39.1%) had radial nerve injury, 18 patients (39.1%) had ulnar nerve injury and 10 patients (27.8%) had median nerve injury.
Mean age of patients with radial nerve injury, ulnar nerve injury and median nerve injury were 29.8 ± 8.1 years, 32.6 ± 7.7 years and 34.8 ± 8.8 years respectively. Mean interval between injury and surgery was around 10 months and mean follow-up period was around 14 months among the studied population.
The current study results revealed that 72.2% of patients with radial nerve injury regained good and satisfactory motor power of wrist, fingers and thumb extensors and returned to pre-injury work with improvement of wrist and finger drop. This was evidenced by significant improvement of functional MRC scale as an objective assessment of functional recovery of motor power of individual muscle from M0 preoperatively to M4 and M3 postoperatively, significant improvement of wrist and finger mean range of extension and thumb opening angle (p < 0.001) and a statistically significant improvement of the overall score of
Conclusions and Summary
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Michigan hand outcomes questionnaire as a subjective assessment for hand function postoperatively (p < 0.001).
While for patients with ulnar nerve injuries, the current study results revealed that most patients with ulnar nerve injury had significant improvement of the motor power of FDP to 4th and 5th fingers with improvement of clawing and 66.7% regained good and satisfactory motor power of adductor pollicis and hand intrinsics and returned to pre-injury work. This was evidenced by significant improvement of functional MRC scale as an objective assessment of functional recovery of motor power of individual muscle from M0 preoperatively to M4 and M3 postoperatively, significant improvement of fingers abduction and adduction, thumb adduction and 4th and 5th fingers flexion (p < 0.001) and a statistically significant improvement of the overall score of Michigan hand outcomes questionnaire as a subjective assessment for hand function postoperatively (p < 0.001).
As reported in this study, most patients with median nerve injury had significant improvement of the motor power of FDS and FDP to 2nd and 3rd fingers with improvement of benediction and 60% regained good and satisfactory motor power of FPL and forearm pronators and returned to pre-injury work. This was evidenced by significant improvement of functional MRC scale as an objective assessment of functional recovery of motor power of individual muscle from M0 preoperatively to M4 and M3 postoperatively, significant improvement of forearm pronation, 2nd and 3rd fingers flexion and thumb IP flexion (p < 0.001) and a statistically significant improvement of the overall score of Michigan hand outcomes questionnaire as a subjective assessment for hand function postoperatively (p < 0.00 .
Regarding factors that may affect clinical outcomes, there is no statistically significant relationship between gender; mechanism of injury and type of occupation, and useful functional recovery.
While the educational level, hand dominance, mean age and mean interval between injury and surgery had a statistically significant association with the useful functional outcome (p < 0.05).
The study results revealed that the degree of improvement of mean ratios of postoperative grip and pinch strengths of the operated hand to that of the opposite side was significantly much better in return to work than in non-return to work population (p < 0.001) regarding patients with radial, ulnar and median nerve injuries.