Multistructural volar wrist lacerations require demanding surgical and microsurgical techniques, with focused postoperative rehabilitation and periodic patient monitoring. We aim to assess epidemiological parameters, prognostic factors, and evaluate the patient's outcome.

Fifty-two patients, with a mean of age 41.8 years old (16–70), were operated for multistuctural volar injuries of the upper limb (zones V to VIII) during the period 2020–2023. Injuries were classified based on the number and type of the injured structures, the time interval between injury and surgery, and the injury mechanism. Age, sensitivity to cold and the modified Allen test, were measured as prognostic factors. Recovery was assessed with the Noaman's system. Grip and pinch strength, and postoperative quickDASH score were evaluated.

Thirty-four patients (33 men) were examined with a mean follow up of 23 months (4–56). All patients were right-handed and half of them injured the dominant limb. The most frequently injured structures were the ulnar nerve in 18 cases, the ulnar artery in 15 cases, and Flexor carpi ulnaris (FCU) tendon in 19. According to Noaman's system, tendon function, thumb opposition and intrinsic muscle function were excellent in 85.3%, 82.4% and 70.6% respectively. In 67.6%, discriminative touch was fair. Five or less injured structures, dominant hand injury, young age and no sensitivity to cold had statistically important correlation with better postoperative results. No correlation was observed between the interval from injury to surgery and the follow-up functional outcomes.

Multistructural lacerations of the wrist should be classified according to the volar anatomic zone of the antibrachial, the number of the injured structures as well as the type of the structure injured. An injured nerve, especially a mixed one like ulnar nerve, indicates a demanding surgical technique, insistence to the treatment algorithm and systematic post operative hand therapy as well as appropriate neuro-triggering medication.

Most patients presented with mild or no postoperative sensitive and motion deficit, while the discriminating finger touch had a moderate recovery. Younger patients with dominant hand injury, five or less injured structures, no sensitivity to cold and non-smokers had better functional outcomes.