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.