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

Abstract

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.