الفهرس 
Wrist and handOnly 14 pages are availabe for public view
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Abstract
Small musculature of the hand bestowed humans with both skills and dexterity. Ulnar nerve injuries have a deleterious impact on the patient’s daily activity with detrimental effects on his professional life. Many patients may have to change their professional career or left with permanent disability. The prognosis of an injury of the ulnar nerve is usually considered poor in comparison to median or radial nerve wherever the level of injury. Specifically, injuries at or above the elbow level exhibit the worst prognosis when managed with primary neurorrhaphy or autogenous nerve grafts. Nerve transfer is a relatively recent procedure added to the evolving reconstructive armamentarium; the traditional nerve repair can do nothing for shortening the time of re-innervations which is crucial for optimum functional outcome. The rational of nerve transfer is based on conversion of the high nerve injuries into low level injuries using expendable nearby nerves, thus providing a shorter time for reinnervations with subsequent better functional outcome. The other beneficial effect of nerve transfer resides in its use as an end to side repair for supercharging of a traditional reconstruction of proximal nerve injury. Revolutionary knowledge of the internal topography of the peripheral nerves expanded the applications of nerve transfer procedures. Numerous experimental studies ascertained the functionality of supercharge end –to-side transfer and reported the same functional outcomes when compared to end-to-end transfer; however, no previous clinical trial compared both techniques. In this study, we tried to compare the functional outcomes of supercharge end to side transfer versus end-to-end transfer of AIN to the ulnar motor nerve in proximal ulnar nerve laceration (Sunderland grade V), in other words, injuries at or proximal to the level of the medial epicondyle. 50 patients with high ulnar nerve laceration were enrolled in the study and randomly assorted into 2 groups A and B. group (A) patients were managed by primary repair of the ulnar nerve at site of injury was done as well as end to side supercharge transfer of the anterior interosseous nerve of pronator quadrates (AIN) to the motor component of the ulnar nerve. For group B patients, primary repair of the ulnar nerve at site of injury and direct end to end transfer of the AIN to the motor component of the ulnar nerve were conducted. Over 18 Months, the patients were closely followed up to trace the initial clinical signs of motor recovery of the small muscles of the hand in addition to DASH score , hand grip strength , key pinch strength as well as electrophysiological changes. The initial clinical signs of recovery were detected in group (A) patients 3 – 6 months postoperatively while group (B) patients recovered ulnar nerve functions at an earlier time 3 – 5 months postoperatively. Regarding postoperative DASH score, group (A) patients reported less disability in comparison to group (B) with mean scores 34.72±3.51 and 40.64±8.95 for group A and B ,respectively. The mean key pinch strength of group (A) patients 11.20±3.15 was higher than group (B) 9.68±3.27. Nevertheless, this higher key pinch strength represents no statistical significance. group (A) patients showed a higher mean hand grip strength 46.64±9.42 in comparison to group (B) patients 39.56±8.12 which is a statistically remarkable difference with a P value 0.006. Moreover, the mean value of the MRC scale of group (A) patients 4.16±0.47 surpassed group (B) 3.00±0.64 making a clear statistical significance with a P value 0.0001.furthermore, the percentage of the patients in group (A) who recovered motor hand function grade 3 or more on MRC scale significantly exceeded their group B counterpart . Electrophysiological studies confirmed the functionality of both supercharge end-to-side transfer as well as end-to-end transfer.