CASE REPORT: 87-1/2 YEAR OLD GENTLEMAN WHO LIVED BY HIMSELF TRIPPED AND FELL THROUGH HIS STORMDOOR ON JANUARY 1. 2001 LACERATING BOTH WRISTS AS HE WENT THROUGH. HE IS RIGHT HAND DOMINANT. HE HAD PULSATILE BLEEDING FROM THE RIGHT HAND AND IT WAS VERY DIFFICULT TO TEST FUNCTION WELL. HE UNDERWENT OPERATIVE EXPLORATION AND REPAIR OF BOTH WRISTS SIMULTANEOUSLY. THE LEFT WRIST HAD A LACERATION ONLY OF THE FLEXOR CARPI ULNARIS WITH THE ULNAR ARTERY AND NERVE INTACT AND OTHER TENDONS INTACT. THESES WERE PRIMARILY REPAIRED AND THE WRIST SLPINTED. THE RIGHT WRIST HAD A DEEP LACERATION PROXIMAL OBLIQUELY PROXIMALLY TO THE WRIST CREASE WHICH COMPLETELY SERVED THE RADIAL ARTERY, THE MEDIAN NERVE, FLEXOR CARPI RADIALIS, FLEXOR CARPI ULNARIS, AND THE SUPERFICIALIS TENDONS OF THE INDEX, MIDDLE, RING, AND LITTLE FINGERS. ALL STRUCTURES WERE REPAIRED USING A MICROSCOPE FOR THE NERVE WITH 8-0 SUTURES. THE RADIAL ARTERY WAS REPAIRED WITH LOOP MAGNIFICATION AND 7-0 PROLENE SUTURES. ALL TENDONS ARE REPAIRED WITH SUPERMID SUTURES AND THE WRIST SPLINTED ACCORDINGLY. POST-OPERATIVELY, HIS COARSE WAS COMPLICATED BY HIS DEMENTIA AND CONFUSION WHICH CLEARED WITH THE APPRORIATE MEDICATION AND RETURNING HIM TO HIS NORMAL SURROUNDINGS.

OVER ONE YEAR POST REPAIR, HE HAS FULL INDEPENDENT FUNCTION OF HIS SUPERFICIALIS TENDONS, AND HE HAS ACTIVE THENAR MUSCULATURE FUNCTION. HE HAS AN INTACT RADIAL ARTERY BY DOPPLER FLOW, TWO POINT DISCRIMINATION TO THE THUMB IS 5.0 MILLIMETERS, THE INDEX 7-9 MILLIMETERS, THE LONG 7.0 MILLIMETERS ON THE RADIAL AND ULNAR SIDE. HE USES HIS HANDS IN HIS GARDENING ACTIVITIES AND HAS ESSENTIALLY NO DISABILITY.

DISCUSSION: IT IS PRESUMED THAT THE ABILITY TO HEAL A NERVE DECREASES WITH AGE. WHEN DISCUSSING THIS GENTLEMAN’S PROGNOSIS WITH HIS FAMILY, I MENTIONED THE LACK OF INFORMATION IN THE LITERATURE ABOUT THE POTENTIAL RESULTS OF NERVE REPAIR IN SOMEONE IN THE LATE 80s. I APPROACHED THE REPAIR AND REHABILITATION LIKE I WOULD HAVE ANY OTHER INDIVIDUAL WHO FELL THROUGH A GLASS DOOR LACERATING THEIR WRISTS. THAT IS REPAIRING ALL STRUCTURES WITH APPROPIATE MAGNIFICATION. THE LESSON TO BE LEARNED FROM THIS GENTELMAN IS THAT THERE IS NO UPPER LIMIT ON AGE FOR AGGRESSIVE REPAIR OF THE NERVE AND TENDON INJURIES.