Young male is admitted in the emergency room with deep blunt laceration in the medial aspect of the right forearm, in association with numbness of the 4th and 5th fingers. However, all the movements of the wrist, hand and fingers are preserved. How should he be managed? Only general measures of antisepsis, suture and antibiotic therapy, or a more detailed investigation targeting a possible neural injury?
The clinical feature indicates that there is unlikely any major injury to ulnar nerve. However as there is open injury with nerve related symptoms, it is definitely a good idea for exploration of the injury area, antisepsis etc.
The following article may help you in taking better decision and follow up
https://www.boa.ac.uk/wp-content/uploads/2014/12/BOAST-5.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110386/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705788/
https://emedicine.medscape.com/article/1270360-treatment
In blunt cut wound in such cases x ray to detect any associated fractures because of blunt trauma. Then if no fracture exploration of wound and debridment of deviatalsed muscles exploration of ulnar nerve and arteries if injured direct repair if posible or grafting if there is gap or tension on repair then muscles or tendons repair the skin closure and postoperative splint with early limited range of motion acorrding the injured structues ad type of repair.
Definitely explore the ulnar nerve. In a mid forearm level the extrinsics will work well. Claw may not manifest immediately. Look at the nerve if he has such specific sensory symptoms.
In acute openulnar nerve injury, immediate exploration and primary neurorrhaphy is recommended as long as the repair can be achieved under minimal tension.
I add a pdf file you can read it.
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