Download PDF
J Wrist Surg 2023; 12(03): 211-217
DOI: 10.1055/s-0042-1756501
Scientific Article

Carpal Tunnel Release Performed during Distal Radius Fracture Surgery

Alyssa Rothman
1   Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
,
Aneesh V. Samineni 
2   Boston University School of Medicine, Boston, Massachusetts
,
David C. Sing
1   Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
,
Joanne Y. Zhang
3   Department of Hand and Upper Extremity Surgery, University of Chicago, Chicago, Illinois
,
Andrew B. Stein
1   Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article.
› Further Information
    Permissions and Reprints

Abstract

Background Carpal tunnel release (CTR) may be concomitantly performed along with distal radius fracture open reduction internal fixation (DRF ORIF) to prevent carpal tunnel syndrome; however, there is little to no literature investigating the rate, risk factors, and complications associated with CTR.

Questions/Purposes The purpose was to determine (1) the rate of CTR performed at time of DRF ORIF, (2) factors associated with CTR, and (3) whether CTR was associated with any complications.

Patients and Methods In this case-control study, adult patients who underwent DRF ORIF from 2014 to 2018 were identified from a national surgical database. Two cohorts were analyzed, (1) patients with CTR and (2) patients without CTR. Preoperative characteristics and postoperative complications were compared with determine factors associated with CTR.

Results Of the 18,466 patients, 769 (4.2%) had CTR. Rates of CTR in patients with intra-articular fractures with two or three fragments were significantly higher than the rate of CTR for patients with extra-articular fractures. Underweight patients underwent CTR at a significantly lower rate compared with overweight and obese patients. The American Society of Anesthesiologists ≥3 was associated with a higher rate of CTR. Male and older patients were less likely to have CTR.

Conclusion The rate of CTR at time of DRF ORIF was 4.2%. Intra-articular fractures with multiple fragments were strongly associated with CTR at time of DRF ORIF, while being underweight, elderly, and male were associated with lower rates of CTR. These findings should be considered when developing clinical guidelines to assess the need for CTR in patients undergoing DRF ORIF. This is a retrospective case control study and reflects level of evidence III.

Keywords

carpal tunnel release - distal radius fracture - open reduction internal fixation - risk factors

Ethical Review Committee Statement

As this study utilized a public, deidentified database that is open to use by participating institutions, no ethical approval was required.


Location: Work was performed at the Boston Medical Center. One of the authors was a resident at Boston Medical Center when the work was performed but recently started the Hand surgery fellowship at University of Chicago, thus a different affiliation has been given.


Informed Consent Declaration

As this study utilized a public, deidentified database that is open to use by participating institutions, no informed consent was required.


Authors' Contributions

All the named authors are actively involved in the planning, enactment and writing up of the study.


A.R.: study idea, data interpretation, manuscript preparation, and editing.


A.V.S.: study idea, data interpretation, manuscript preparation, and editing.


D.C.S.: study idea, statistical analysis, data interpretation, manuscript preparation, and editing.


J.Y.Z.: study idea, data interpretation, manuscript preparation, and editing.


A.B.S.: data interpretation, manuscript preparation, and editing.




Publication History

Received: 03 February 2022

Accepted: 30 June 2022

Article published online:
09 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
    CrossrefPubMedGoogle Scholar
  • 2 Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983; 202: 1-109
    PubMedGoogle Scholar
  • 3 Cooper C, Dennison EM, Leufkens HGM, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res 2004; 19 (12) 1976-1981
    CrossrefPubMedGoogle Scholar
  • 4 Rennie L, Court-Brown CM, Mok JYQ, Beattie TF. The epidemiology of fractures in children. Injury 2007; 38 (08) 913-922
    CrossrefPubMedGoogle Scholar
  • 5 Ward WT, Rihn JA. The impact of trauma in an urban pediatric orthopaedic practice. J Bone Joint Surg Am 2006; 88 (12) 2759-2764
    CrossrefPubMedGoogle Scholar
  • 6 Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care 2014; 3 (04) 325-332
    CrossrefPubMedGoogle Scholar
  • 7 Melton III LJ, Amadio PC, Crowson CS, O'Fallon WM. Long-term trends in the incidence of distal forearm fractures. Osteoporos Int 1998; 8 (04) 341-348
    CrossrefPubMedGoogle Scholar
  • 8 de Putter CE, van Beeck EF, Looman CWN, Toet H, Hovius SER, Selles RW. Trends in wrist fractures in children and adolescents, 1997-2009. J Hand Surg Am 2011; 36 (11) 1810-1815.e2
    CrossrefPubMedGoogle Scholar
  • 9 Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T. Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone 1999; 24 (03) 265-270
    CrossrefPubMedGoogle Scholar
  • 10 Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury 2004; 35 (05) 462-466
    CrossrefPubMedGoogle Scholar
  • 11 McKay SD, MacDermid JC, Roth JH, Richards RS. Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 2001; 26 (05) 916-922
    CrossrefPubMedGoogle Scholar
  • 12 Geissler WB, Slade JF. Fracture of the carpal bones. In: Green DP, Wolfe SW. eds. Green's Operative and Surgery. Philadelphia, PA: Saunders/Elsevier; 2011. 6th edition.
    CrossrefGoogle Scholar
  • 13 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (04) 613-619
    CrossrefPubMedGoogle Scholar
  • 14 Tosti R, Ilyas AM. Acute carpal tunnel syndrome. Orthop Clin North Am 2012; 43 (04) 459-465
    CrossrefPubMedGoogle Scholar
  • 15 Bauman TD, Gelberman RH, Mubarak SJ, Garfin SR. The acute carpal tunnel syndrome. Clin Orthop Relat Res 1981; (156) 151-156
    PubMedGoogle Scholar
  • 16 Chauhan A, Bowlin TC, Mih AD, Merrell GA. Patient-reported outcomes after acute carpal tunnel release in patients with distal radius open reduction internal fixation. Hand (N Y) 2012; 7 (02) 147-150
    CrossrefPubMedGoogle Scholar
  • 17 Gelberman RH, Szabo RM, Mortensen WW. Carpal tunnel pressures and wrist position in patients with colles' fractures. J Trauma 1984; 24 (08) 747-749
    CrossrefPubMedGoogle Scholar
  • 18 Henry M, Stutz C. A prospective plan to minimise median nerve related complications associated with operatively treated distal radius fractures. Hand Surg 2007; 12 (03) 199-204
    CrossrefPubMedGoogle Scholar
  • 19 Paley D, McMurtry RY. Median nerve compression by volarly displaced fragments of the distal radius. Clin Orthop Relat Res 1987; (215) 139-147
    PubMedGoogle Scholar
  • 20 Szabo RM, Gelberman RH, Williamson RV, Hargens AR. Effects of increased systemic blood pressure on the tissue fluid pressure threshold of peripheral nerve. J Orthop Res 1983; 1 (02) 172-178
    CrossrefPubMedGoogle Scholar
  • 21 Dyer G, Lozano-Calderon S, Gannon C, Baratz M, Ring D. Predictors of acute carpal tunnel syndrome associated with fracture of the distal radius. J Hand Surg Am 2008; 33 (08) 1309-1313
    CrossrefPubMedGoogle Scholar
  • 22 Earp BE, Mora AN, Floyd WE, Blazar PE. Predictors of acute carpal tunnel syndrome following ORIF of distal radius fractures: a matched case–control study. J Hand Surg Glob Online 2019
    PubMedGoogle Scholar
  • 23 American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2012 ACS NSQIP Participant Use Data File. Accessed July 16, 2022 at: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/participant-use-data-file/
    PubMedGoogle Scholar
  • 24 Nishimura A, Ogura T, Hase H. et al. Evaluation of sensory function after median nerve decompression in carpal tunnel syndrome using the current perception threshold test. J Orthop Sci 2003; 8 (04) 500-504
    CrossrefPubMedGoogle Scholar
  • 25 Puchalski P, Zyluk A. Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors. J Hand Surg [Br] 2005; 30 (06) 574-580
    CrossrefPubMedGoogle Scholar
  • 26 Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000; 25 (01) 19-28
    CrossrefPubMedGoogle Scholar
  • 27 Itsubo T, Hayashi M, Uchiyama S, Hirachi K, Minami A, Kato H. Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists. J Orthop Sci 2010; 15 (04) 518-523
    CrossrefPubMedGoogle Scholar
  • 28 Stevens JC, Beard CM, O'Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 1992; 67 (06) 541-548
    CrossrefPubMedGoogle Scholar
  • 29 Mondelli M, Aprile I, Ballerini M. et al. Sex differences in carpal tunnel syndrome: comparison of surgical and non-surgical populations. Eur J Neurol 2005; 12 (12) 976-983
    CrossrefPubMedGoogle Scholar
  • 30 Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand Clin 2002; 18 (02) 257-268
    CrossrefPubMedGoogle Scholar
  • 31 Ekman-Ordeberg G, Sälgeback S, Ordeberg G. Carpal tunnel syndrome in pregnancy. A prospective study. Acta Obstet Gynecol Scand 1987; 66 (03) 233-235
    CrossrefPubMedGoogle Scholar
  • 32 Yeh KT, Lee RP, Yu TC. et al. Risk factors for carpal tunnel syndrome or trigger finger following distal radius fracture: a nationwide study. Sci Rep 2020; 10 (01) 469
    CrossrefPubMedGoogle Scholar
  • 33 Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4: 9
    CrossrefPubMedGoogle Scholar
  • 34 Dale AM, Descatha A, Coomes J, Franzblau A, Evanoff B. Physical examination has a low yield in screening for carpal tunnel syndrome. Am J Ind Med 2011; 54 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 35 Odumala O, Ayekoloye C, Packer G. Prophylactic carpal tunnel decompression during buttress plating of the distal radius–is it justified?. Injury 2001; 32 (07) 577-579
    CrossrefPubMedGoogle Scholar