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J Hand Microsurg 2018; 10(01): 026-028
DOI: 10.1055/s-0037-1618913
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Decreased Rate of Complications in Carpal Tunnel Release with Hand Fellowship Training

Santosh J. Mathen
1   The Indiana Hand to Shoulder Center, Indianapolis, Indiana, United States
,
Naveed N. Nosrati
2   Division of Plastic Surgery, Indiana University, Indianapolis, Indiana, United States
,
Gregory A. Merrell
1   The Indiana Hand to Shoulder Center, Indianapolis, Indiana, United States
› Author Affiliations
Further Information

Publication History

Received: 23 January 2017

Accepted: 19 November 2017

Publication Date:
20 March 2018 (online)

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Abstract

Purpose In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs.

Materials and Methods Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates’ case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance.

Results A total of 29,916 cases were identified. Hand fellowship–trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship–trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications.

Conclusion Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.

Keywords

hand fellowship - carpal tunnel release - median nerve