Carpal Tunnel Release Performed during Distal Radius Fracture Surgery

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.

Publikationsverlauf

Eingereicht: 03. Februar 2022

Angenommen: 30. Juni 2022

Artikel online veröffentlicht:
09. November 2022

• References

• 1 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
• 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
• 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
• 4 Rennie L, Court-Brown CM, Mok JYQ, Beattie TF. The epidemiology of fractures in children. Injury 2007; 38 (08) 913-922
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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.
• 13 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (04) 613-619
• 14 Tosti R, Ilyas AM. Acute carpal tunnel syndrome. Orthop Clin North Am 2012; 43 (04) 459-465
• 15 Bauman TD, Gelberman RH, Mubarak SJ, Garfin SR. The acute carpal tunnel syndrome. Clin Orthop Relat Res 1981; (156) 151-156
• 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
• 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
• 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
• 19 Paley D, McMurtry RY. Median nerve compression by volarly displaced fragments of the distal radius. Clin Orthop Relat Res 1987; (215) 139-147
• 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
• 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
• 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
• 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/
• 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
• 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
• 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
• 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
• 28 Stevens JC, Beard CM, O'Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 1992; 67 (06) 541-548
• 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
• 30 Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand Clin 2002; 18 (02) 257-268
• 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
• 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
• 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
• 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
• 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