Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists

Itsubo, Toshiro; Hayashi, Mito; Uchiyama, Shigeharu; Hirachi, Kazuhiko; Minami, Akio; Kato, Hiroyuki

doi:10.1007/s00776-010-1496-7

Cited by 35 publications

(42 citation statements)

References 15 publications

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“…Carpal tunnel syndrome (CTS) is a well-described complication following distal radius fractures, with a reported incidence of 3.3%–17.2% 15 . In our study this rate was found to be %12 (3 of 24 patients).Only 1 patient required surgical release who had moderate symptoms.…”

Section: Discussionmentioning

confidence: 49%

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Zengin¹,

Özcan²,

Aslan³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate the efficacy of conservative treatment (cast immobilization) for complex intra-articular distal radius fractures (AO type C) in elderly patients and to determine whether or not the application of a volar locking plate (VLP) is necessary.MethodsA retrospective study on patients treated at two different clinics was conducted between 2014 and 2016. A total of 49 elderly patients ≥60 years old were treated either operatively with volar locking plate fixation (n = 25; 7 males and 18 females; mean age: 66.6 ± 7.4 years) or conservatively with cast immobilisation (n = 24; 7 males and 17 females; mean age: 68.9 ± 8.7 years) for complex intra-articular distal fractures. Clinical, functional and radiological evaluations were conducted at the final follow-up examinations of the patients.ResultsThere was no statistically significant difference between the two groups of patients with respect to the follow-up periods, gender, age and fracture type (p > 0.05). At the end of mean follow-up time of 16 months the grip strength (p = 0.03), radial tilt (p = 0.06), radial inclination (p = 0.01), radial height (p = 0.01) and articular step-off (p = 0.02) were significantly better in the volar locking plate group, while there was no significant difference between the functional results (based on the Quick Disabilities of the Arm, Shoulder and Hand score) (p = 0.8) and range of motion. The grip strength was significantly higher in the VLP group when compared to the cast group (p = 0.03).ConclusionThe results of this study suggest that the locking plate fixation for the complex intra-articular distal radius fractures provides better results for the grip strength and radiographic parameters than cast immobilization in patients ≥60 years old, while no difference was found between the clinical and functional results.Level of EvidenceLevel III, Therapeutic Study.

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Section: Discussionmentioning

confidence: 49%

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Zengin¹,

Özcan²,

Aslan³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…Accordingly, we averaged the proportion of cases undergoing prophylactic CTR (0.108) and developing acute CTS after DRFx-ORIF (0.011) in the current population to arrive at a pre-sampling estimate of the proportion of our case-defining condition (.05) for the power analysis. A review of reported incidences of acute CTS (Dyer et al, 3 5.1%; Itsubo et al, 14 3.3% to 17%) confirmed that 5% was a reasonable estimate for the incidence of acute CTS after DRFx-ORIF. All patients were diagnosed clinically because in our area, a surgical delay to obtain confirmatory testing would be considered outside the standard of care.…”

Section: Discussionmentioning

confidence: 95%

“…Most authors concluded that acute CTS usually results from edema within the carpal tunnel, causing increased pressure and subsequent epineural ischemia. 2,4,9,14 The current study focused on patients whom Esenwein et al 15 and Itsubo et al 14 would classify as acute. All of these patients developed symptoms within a week, but not all came to medical attention within a week, nor did everyone undergo a release on the same day as the diagnosis.…”

Section: Discussionmentioning

confidence: 97%

“…The current C-type and open fracture findings also coincide with prior reports. Itsubo et al 14 grouped 105 wrists into the categories of acute (28 wrists, CTS within 1 week of fracture), subacute (47 wrists, CTS onset 1 to 12 weeks after fracture), and delayed onset (30 wrists, more than 12 weeks after fracture) and found that 68% of the acute onset group had AO C-type fractures, a statistically significant difference in the prevalence of this fracture type among the 3 groups. In a 1-year follow-up of 665 patients, Esenwein et al 15 found that 22 (3%) had developed CTS; 5 patients (3 with AO C-type fractures, 1 with an open fracture, and 1 with thrombophilia) developed acute median nerve compression requiring immediate CTR.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Acute Carpal Tunnel Syndrome Following ORIF of Distal Radius Fractures: A Matched Case–Control Study

Earp

Mora

Floyd

et al. 2019

Journal of Hand Surgery Global Online

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acute carpal tunnel syndrome carpal tunnel release complications distal radius fracture Purpose: Acute carpal tunnel syndrome (CTS) can develop after distal radius fractures (DRFx), necessitating urgent carpal tunnel release (CTR). This complication has not been specifically investigated after open reduction internal fixation (ORIF) of DRFx (DRFx-ORIF). Identifying risk factors would allow for better definition of the indications for prophylactic CTR at the time of DRFx-ORIF. Methods: We reviewed the records of 1,750 patients who underwent DRFx-ORIF at 2 level I trauma centers over 90 months. Of these patients, 10.7% underwent simultaneous CTR with DRFx-ORIF. Twenty patients who developed acute CTS within 3 weeks after DRFx-ORIF were identified. A case-controlled methodology was used; each patient was matched with 4 control patients who were treated with DRFx-ORIF but did not develop acute CTS on the operative limb. Differences between cases and controls were evaluated via univariable logistic regression modeling. Multivariate analysis was not performed because of the relatively small size of the cohort. Results: The development of acute CTS after DRFx surgical treatment resulted in 1.1% of patients returning to the operating room for an urgent second surgery. Three statistically significant risk factors for the development of acute CTS after DRFx-ORIF were identified via univariable analysis. Open fractures, AO C-type DRFx, and any intervening surgical procedure between injury and DRFx-ORIF were associated with greater relative odds of developing acute CTS. Conclusions: Patients with open fractures, AO C-type DRFx, and any intervening surgical procedure are at increased risk for developing acute CTS after DRFx-ORIF and warrant consideration for prophylactic release at the time of DRFx-ORIF. Type of study/level of evidence: Therapeutic III.

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“…How-*Corresponding Author: Yukichi Zenke, Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Japan. Yahatanisiku, Kitakyusyu 807-8555, Japan, Tel: +81-93-691-7444, Fax: +81-93-692-0184, E-mail: ukichi.drz@gmail.com ever, complications resulting from this treatment have also been reported [4][5][6]. Many Colles' fractures are still treated conservatively in clinics without hospitalization [7].…”

Section: Introductionmentioning

confidence: 99%

Radiographic Measurements as a Predictor of Correction Loss in Conservative Treatment of Colles’ Fracture

Zenke

Furukawa

Furukawa³

et al. 2019

J UOEH

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Dorsal displaced distal radius fracture (Colles' fracture) is very common and could occur from fragility in middle-aged and elderly people. Many Colles' fractures are still treated conservatively in clinics without hospitalization. Internal fixation using a palmar locking plate has been the standard treatment, but some complications have been reported. The aim of this study was to analyze changes in radiographic parameters over time in patients with conservatively treated Colles' fractures, and to establish whether the type of fracture influenced these changes. Prospective data collected included patient characteristics and radiological findings. The study was conducted at two private clinics and included 60 patients (13 men and 47 women; mean age, 72.5 years old; range, 55 to 96 years old) with a Colles' fracture (types of injury: intramedullary [n = 15], anatomical [n = 39], extramedullary [n = 2], and unknown [n = 4]) who were treated conservatively with manipulation and cast immobilization. Conservative, nonsurgical treatment with manipulation was performed first, then, cast immobilization continued for 4 weeks. Loss of correction between the time of reduction and the final observation was defined by the following radiographic measurements: palmar tilt, radial inclination, and ulnar variance. The average final follow up period was 4.6 months (1.5-12 months). Immediately after reduction, 11 intramedullary fractures, 42 anatomical fractures and 7 extramedullary fractures were confirmed. Correction loss according to ulnar variance was significantly greater (P = 0.012) during the final observation for patients with an intramedullary injury at reduction than that for patients with extramedullary and anatomical injuries at reduction. We found that the correction loss for ulnar variance from immediately after reduction until the final observation was significantly greater in the intramedullary group, suggesting that an alternative to conservative treatment may be beneficial for patients with intramedullary fractures.

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Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists

Cited by 35 publications

References 15 publications

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older

Predictors of Acute Carpal Tunnel Syndrome Following ORIF of Distal Radius Fractures: A Matched Case–Control Study

Radiographic Measurements as a Predictor of Correction Loss in Conservative Treatment of Colles’ Fracture

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