J Wrist Surg 2016; 05(03): 241-246
DOI: 10.1055/s-0036-1581053
Wrist and Carpal Anatomy
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study

Michael P. Gaspar
1   Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
,
Blane A. Sessions
1   Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Bryan S. Dudoussat
2   Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Patrick M. Kane
1   Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

05 January 2016

16 February 2016

Publication Date:
29 March 2016 (online)

Abstract

Background The safety of surgical approaches for single- versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial.

Purpose The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely.

Methods Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded.

Results Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel.

Conclusions Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.

Note

This study was performed at the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.


 
  • References

  • 1 Owen RA, Melton III LJ, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles' fracture in a North American community. Am J Public Health 1982; 72 (6) 605-607
  • 2 Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am 2011; 36 (8) 1282-1287
  • 3 Farner S, Malkani A, Lau E, Day J, Ochoa J, Ong K. Outcomes and cost of care for patients with distal radius fractures. Orthopedics 2014; 37 (10) e866-e878
  • 4 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (9) 1855-1861
  • 5 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (4) 613-619
  • 6 Brüske J, Niedźwiedź Z, Bednarski M, Zyluk A. Acute carpal tunnel syndrome after distal radius fractures—long term results of surgical treatment with decompression and external fixator application [in Polish]. Chir Narzadow Ruchu Ortop Pol 2002; 67 (1) 47-53
  • 7 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 (8) 1309-1313
  • 8 Bienek T, Kusz D, Cielinski L. Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg [Br] 2006; 31 (3) 256-260
  • 9 Tannan SC, Pappou IP, Gwathmey FW, Freilich AM, Chhabra AB. The extended flexor carpi radialis approach for concurrent carpal tunnel release and volar plate osteosynthesis for distal radius fracture. J Hand Surg Am 2015; 40 (10) 2026-2031.e1
  • 10 Fuller DA, Barrett M, Marburger RK, Hirsch R. Carpal canal pressures after volar plating of distal radius fractures. J Hand Surg [Br] 2006; 31 (2) 236-239
  • 11 Odumala O, Ayekoloye C, Packer G. Prophylactic carpal tunnel decompression during buttress plating of the distal radius—is it justified?. Injury 2001; 32 (7) 577-579
  • 12 Orbay JL, Badia A, Indriago IR , et al. The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 2001; 5 (4) 204-211
  • 13 Mack GR, McPherson SA, Lutz RB. Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release. Clin Orthop Relat Res 1994; (300) 141-146
  • 14 Ilyas AM. Surgical approaches to the distal radius. Hand (NY) 2011; 6 (1) 8-17
  • 15 Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A. Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg Am 2008; 33 (7) 1135-1143
  • 16 Pensy RA, Brunton LM, Parks BG, Higgins JP, Chhabra AB. Single-incision extensile volar approach to the distal radius and concurrent carpal tunnel release: cadaveric study. J Hand Surg Am 2010; 35 (2) 217-222
  • 17 Weber RA, Sanders WE. Flexor carpi radialis approach for carpal tunnel release. J Hand Surg Am 1997; 22 (1) 120-126
  • 18 Gwathmey Jr FW, Brunton LM, Pensy RA, Chhabra AB. Volar plate osteosynthesis of distal radius fractures with concurrent prophylactic carpal tunnel release using a hybrid flexor carpi radialis approach. J Hand Surg Am 2010; 35 (7) 1082-1088.e4