PurposePatients who fracture their distal radius are at risk for developing carpal tunnel syndrome (CTS). Carpal tunnel syndrome occurs acutely; other patients may present with signs and symptoms of carpal tunnel syndrome weeks or months after the distal radius fracture. Because CTS may present in a delayed fashion after a distal radius fracture, some surgeons will perform carpal tunnel release in patients who undergo open reduction and internal fixation (ORIF) even in those patients who do not have clinical evidence of carpal tunnel syndrome – a prophylactic carpal tunnel release. In the current systematic review, we evaluated the literature regarding prophylactic carpal tunnel release in the setting of operative treatment of distal radius fractures. MethodsWe conducted our literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 1).1 The search strategy reflected “prophylactic carpal tunnel release during treatment of distal radius fractures,” and was conducted in February 2024. Included studies are summarized in Table 1. Results6 studies met inclusion criteria. Publication dates ranged from 2001 to 2018. 5 studies investigated clinical symptoms and/or electromyography: 3 out of 5 studies found worsening or persistent median neuropathy, and 2 out of 5 studies found improvement or no further development of symptoms in their respective patient cohorts. The 6th study found no difference in patient reported outcomes between either approach. ConclusionsThere were no differences in wrist range of motion, post-operative grip strength, or patient reported outcomes within each of the study cohorts. Based on the findings from the studies included in this review, we do not believe that there is sufficient evidence supporting prophylactic CTR in the setting of operative treatment of distal radius fractures.