PURPOSE: A better understanding of the risk factors for acute carpal tunnel syndrome (CTS) associated with fracture of the distal radius might influence recommendations for prophylactic carpal tunnel release. METHODS: Fifty patients who had release of an acute CTS in association with open reduction and internal fixation (ORIF) of a fracture of the distal radius were identified from orthopedic trauma databases at 2 institutions. Each patient was matched with a control patient (ORIF, but no acute CTS) of the same gender, similar age (+/-4 years), and similar injury mechanism. RESULTS: The prevalence of acute CTS among patients with a surgically treated fracture of the distal radius was 5.4%. In univariate analysis, only fracture translation was a significant predictor of acute CTS, but ipsilateral upper extremity trauma and status as a multitrauma patient were nearly significant. The best multivariate model included fracture translation alone and accounted for 60% of the observed increase in risk. A subgroup analysis using receiver operating characteristics (ROC) identified a threshold of approximately 35% fracture translation associated with a significantly increased risk of acute CTS in women less than 48 years of age. No threshold was identified in the other 3 subgroups. CONCLUSIONS: Fracture translation is the most important risk factor for acute CTS in patients who subsequently had ORIF of a fracture of the distal radius. On the basis of these data, prophylactic carpal tunnel release might be appropriate in women less than 48 years of age with greater than 35% fracture translation, but further investigation is needed to confirm that a true threshold exists.
PURPOSE: A better understanding of the risk factors for acute carpal tunnel syndrome (CTS) associated with fracture of the distal radius might influence recommendations for prophylactic carpal tunnel release. METHODS: Fifty patients who had release of an acute CTS in association with open reduction and internal fixation (ORIF) of a fracture of the distal radius were identified from orthopedic trauma databases at 2 institutions. Each patient was matched with a control patient (ORIF, but no acute CTS) of the same gender, similar age (+/-4 years), and similar injury mechanism. RESULTS: The prevalence of acute CTS among patients with a surgically treated fracture of the distal radius was 5.4%. In univariate analysis, only fracture translation was a significant predictor of acute CTS, but ipsilateral upper extremity trauma and status as a multitrauma patient were nearly significant. The best multivariate model included fracture translation alone and accounted for 60% of the observed increase in risk. A subgroup analysis using receiver operating characteristics (ROC) identified a threshold of approximately 35% fracture translation associated with a significantly increased risk of acute CTS in women less than 48 years of age. No threshold was identified in the other 3 subgroups. CONCLUSIONS:Fracture translation is the most important risk factor for acute CTS in patients who subsequently had ORIF of a fracture of the distal radius. On the basis of these data, prophylactic carpal tunnel release might be appropriate in women less than 48 years of age with greater than 35% fracture translation, but further investigation is needed to confirm that a true threshold exists.
Authors: Joideep Phadnis; Alex Trompeter; Kieran Gallagher; Lucy Bradshaw; David S Elliott; Kevin J Newman Journal: J Orthop Surg Res Date: 2012-01-26 Impact factor: 2.359
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