Surgical Decision-Making in Median Neuropathy Associated with Distal Radius Fractures

Abstract

Objectives A lack of conclusive evidence on the treatment of acute median neuropathy (AMN) in patients with distal radius fractures has led to inconsistent surgical guidelines and recommendations regarding AMN in distal radius fractures. There is a wide variation in surgical decision-making. We aimed to evaluate international differences between surgical considerations and practices related to carpal tunnel release (CTR) in the setting of distal radius fractures.

Methods We approached surgeons who were a member of the Orthopaedic Trauma Association (United States) or of the Dutch Trauma Society (the Netherlands) and asked them to provide sociodemographic information and information on their surgical practice regarding CTR in the setting of distal radius fractures. After applying our exclusion criteria, our final cohort consisted of 127 respondents.

Results Compared with Dutch surgeons, surgeons from the United States are more of the opinion that displaced distal radius fractures are at risk of developing acute carpal tunnel syndrome (ACTS), consider persistent paresthesia in the median nerve distribution after closed reduction to be a surgical emergency less often, and are more likely to perform a CTR if there are signs of ACTS in the setting of a distal radius fracture.

Conclusion A lack of conclusive evidence has led to international differences in surgical practice regarding the treatment of ACTS in the setting of distal radius fractures. Future research should guide surgeons in making appropriate evidence-based decisions when performing CTR in the setting of distal radius fractures.

Level of Evidence This is a Level V study.

Keywords

distal radius fractures - carpal tunnel release - median nerve

Author Contributions

This study represents a great deal of effort, resources, and dedication on the part of the authors in reviewing and reconstructing all cases, reviewing the literature, and performing statistical analyses. All authors have participated in a material way. S. Ö., C. M., F. B., M. H., B. E., and C. W. contributed to the study design, S. Ö., B. E., and C. W. contributed to data collection, S. Ö., C. M., and F. B. contributed to data analysis, S. Ö., B. E., C. M., F. B., and M. H. contributed to the initial draft, S. Ö., C. M., F. B., M. H., and C. W. contributed to data accuracy.

Note

The work was performed at the Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Ethical Review Committee Statement

The Institutional Review Board determined that this study met the formal criteria for exemption.

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