Severe Spaghetti Wrist Injury With Complete Laceration of Median Nerve, Radial and Ulnar Arteries, and Multiple Flexor Tendons: A Case Report and Literature Review

Spaghetti wrist injuries are complex distal forearm lacerations involving flexor tendons, nerves, and vessels, associated with significant functional morbidity. We present the case of a 64-year-old right-handed man with a deep cut wound to his left forearm and clinical signs of distal ischemia, complete loss of digital flexion, and palmar anesthesia. An urgent examination was performed, identifying sections of the radial and ulnar arteries, median nerve, and injuries to the palmaris longus, flexor carpi ulnaris, flexor carpi radialis, superficial and deep flexor tendons of the fingers, and flexor pollicis longus tendons. Surgical repair followed by rehabilitation was performed. At six months, the patient demonstrated palmar sensory recovery and total active motion (TAM) of 73% compared with the contralateral hand, with residual limitation in digital flexion. This report highlights a severe spaghetti wrist injury with dual-artery transection causing distal ischemia and complete median nerve laceration, managed with single-stage primary tendon, vascular, and nerve repair, and reviews reconstructive options, repair sequencing, and rehabilitation strategies based on recent literature.