The rate and associated risk factors for acute carpal tunnel syndrome complicating a fracture of the distal radius

Jun Min Leow,Nicholas D Clement,Andrew D Duckworth,Margaret M Mcqueen

doi:10.1007/s00590-021-02975-5

Jun Min Leow, Nicholas D Clement + Show 2 more

Open Access

https://doi.org/10.1007/s00590-021-02975-5

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Abstract

BackgroundAcute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius.MethodsA retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS.ResultsThere were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS.ConclusionFour percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented.Level of evidence:III.

Highlights

Acute carpal tunnel syndrome (ACTS) is a recognised complication following a fracture of the distal radius and is due to elevated compartment pressure within the carpal tunnel [1,2,3]
This study has defined the epidemiology, symptoms and signs, and management of patients presenting with ACTS complicating a fracture of the distal radius
The classical predisposing factors for idiopathic CTS were not associated with the development of ACTS

Summary

Introduction

Acute carpal tunnel syndrome (ACTS) is a recognised complication following a fracture of the distal radius and is due to elevated compartment pressure within the carpal tunnel [1,2,3]. The Carpal Tunnel Syndrome-6 (CTS-6) is a six-item clinical diagnostic algorithm that takes into consideration two symptoms (paraesthesia in the median nerve distribution and nocturnal symptoms), two signs of advanced disease (atrophy of thenar muscles and reduced 2-point discrimination) and two positive provocation tests (Tinel’s test and Phalen’s test) [14]. It is intended for cases of chronic carpal tunnel syndrome, as the provocative tests do not exhibit good sensitivity and are difficult to perform in ACTS.

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