Wrist Trauma Research Articles

The potential benefit of artificial intelligence regarding clinical decision-making in the treatment of wrist trauma patients

PurposeThe implementation of artificial intelligence (AI) in health care is gaining popularity. Many publications describe powerful AI-enabled algorithms. Yet there’s only scarce evidence for measurable value in terms of patient outcomes, clinical decision-making or socio-economic impact. Our aim was to investigate the significance of AI in the emergency treatment of wrist trauma patients.MethodTwo groups of physicians were confronted with twenty realistic cases of wrist trauma patients and had to find the correct diagnosis and provide a treatment recommendation. One group was assisted by an AI-enabled application which detects and localizes distal radius fractures (DRF) with near-to-perfect precision while the other group had no help. Primary outcome measurement was diagnostic accuracy. Secondary outcome measurements were required time, number of added CT scans and senior consultations, correctness of the treatment, subjective and objective stress levels.ResultsThe AI-supported group was able to make a diagnosis without support (no additional CT, no senior consultation) in significantly more of the cases than the control group (75% vs. 52%, p = 0.003). The AI-enhanced group detected DRF with superior sensitivity (1.00 vs. 0.96, p = 0.06) and specificity (0.99 vs. 0.93, p = 0.17), used significantly less additional CT scans to reach the correct diagnosis (14% vs. 28%, p = 0.02) and was subjectively significantly less stressed (p = 0.05).ConclusionThe results indicate that physicians can diagnose wrist trauma more accurately and faster when aided by an AI-tool that lessens the need for extra diagnostic procedures. The AI-tool also seems to lower physicians' stress levels while examining cases. We anticipate that these benefits will be amplified in larger studies as skepticism towards the new technology diminishes.

Mapping wrist motion: 3D CT analysis after scapholunate ligament transection.

The injury of the scapholunate (SL) ligament is common in wrist traumas leading to pain and reduced wrist function. The wrist's unique joint design and possible underlying theories as the carpal row theory were subject to earlier investigations studying wrist kinematics. Nevertheless, a comprehensive understanding of how SL ligament injuries affect wrist biomechanics is still lacking. Through a quantitative analysis of carpal bone motion patterns, we evaluated the impact on wrist kinematics occurring after SL ligament injury. We conducted a study using computer tomography imaging to analyse wrist kinematics after SL ligament transection in 21 fresh-frozen anatomical specimens. The collected data were then transformed into 3D models, employing both standardized global and object coordinate systems. The study encompassed the evaluation of rotation and translation for each individual carpal bone, as well as the ulna, and all metacarpal bones in reference to the radius. The study showed a significant increase in rotation towards palmar (p < 0.01), particularly notable for the scaphoid, following transection of the SL ligament during palmar flexion. Ulnar deviation did not significantly affect rotation or translation, and radial deviation also showed no significant changes in rotation or translation. The study highlights the significance of the SL ligament in wrist kinematics, revealing that SL ligament tears lead to changes in wrist motion. While we observed significant rotational changes for the scaphoid, other carpal bones showed less pronounced alterations, emphasizing the complexity of wrist biomechanics.

Protocol for a systematic review and network meta-analysis of the use of prophylactic antibiotics in hand trauma surgery

BackgroundThe use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.Methods and analysisThe databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. s will be screened by two persons independently to identify eligible studies.This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device).The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies.A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta‐Analysis (CINEMA).DiscussionThis systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing.Systematic review registrationPROSPERO CRD42023429618.

YOLOv9 for fracture detection in pediatric wrist trauma X‐ray images

AbstractThe introduction of YOLOv9, the latest version of the you only look once (YOLO) series, has led to its widespread adoption across various scenarios. This paper is the first to apply the YOLOv9 algorithm model to the fracture detection task as computer‐assisted diagnosis to help radiologists and surgeons to interpret X‐ray images. Specifically, this paper trained the model on the GRAZPEDWRI‐DX dataset and extended the training set using data augmentation techniques to improve the model performance. Experimental results demonstrate that compared to the mAP 50–95 of the current state‐of‐the‐art model, the YOLOv9 model increased the value from 42.16% to 43.73%, with an improvement of 3.7%. The implementation code is publicly available at https://github.com/RuiyangJu/YOLOv9‐Fracture‐Detection.

Proprioceptive rehabilitation strategies in posttraumatic wrist injuries. Scoping review.

The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality. To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries. A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated. After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates. Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.

Kienböck Disease following a Single Wrist Traumatic Incident: A Scoping Review

AbstractThe incidence of Kienböck disease after a single wrist traumatic incident is rare but has been reported by several authors. Although most evidence consists of case reports and case series, two possible concerns have been suggested. First, a traumatic alteration of the wrist anatomy and measurements increase stresses on the lunate. These changes mostly follow fractures around the wrist and can be regarded as acquired risk factors that contribute to the development of Kienböck disease. Second, some wrist injuries may tear ligaments around the lunate and damage the accompanied blood vessels; so, compromising the circulation to the lunate. Surgeons should be aware of the development of Kienböck disease following a single wrist trauma to enable early diagnosis and management to improve outcomes. Level of evidence Etiology IV.

Evaluation of a cadaveric wrist motion simulator using marker-based X-ray reconstruction of moving morphology.

Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower's motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.

Reconstruction of a Wrist Defect with a Distally-Based Radial Artery Perforator Flap: A Case Report

Introduction: Because of the important anatomical structures situated superficially, reconstruction of wrist soft tissue defects is challenging for the plastic surgeon. Depending on the characteristics of the defect, various reconstruction methods are commonly performed. A pedicled perforator flap stands as a valuable option providing reliable coverage of the defect while preserving the vascularity. Case report: A 35-year-old male presented with a post traumatic wrist soft tissue defect with exposure of underlying structures. Surgical debridement was performed, and the resulting defect was reconstructed with a distally-based radial artery pedicled perforator flap. Postoperative recovery was uncomplicated. Conclusion: Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the wrist. It has many of the benefits of the radial forearm flap but minimizes the disadvantages.

Post-traumatic carpal tunnel syndrome in children

BackgroundGiven limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population. MethodsIn this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ2 and independent sample t-tests were used for subgroup comparisons. Results18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1–6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001). ConclusionsPost-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes. Key Concepts(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes. Level of EvidenceIV Case Series

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol.

Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma. This will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria. The Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication.

The rate of nonunion in the MRI-detected occult scaphoid fracture.

There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion. A total of 1,989 patients underwent acute MRI for a suspected scaphoid fracture during the study period, of which 256 patients (12.9%) were diagnosed with a previously occult scaphoid fracture. Of the patients with scaphoid fractures, six underwent early surgical fixation (2.3%) and there was a total of 16 cases of delayed or nonunion (6.3%) in the remaining 250 patients treated with cast immobilization. Of the nine nonunions (3.5%), seven underwent surgery (2.7%), one opted for non-surgical treatment, and one failed to attend follow-up. Of the seven delayed unions (2.7%), one (0.4%) was treated with surgery at two months, one (0.4%) did not attend further follow-up, and the remaining five fractures (1.9%) healed after further cast immobilization. All fractures treated with surgery had united at follow-up. There was one complication of surgery (prominent screw requiring removal). MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion of scaphoid fractures diagnosed only after MRI seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. This study adds weight to the evidence base supporting the use of early MRI for these patients.

NanoScope wrist arthroscopy under wide-awake local anesthesia with no tourniquet: A prospective series of 30 consecutive patients

IntroductionWrist arthroscopy is an evolving procedure. The purpose of this study was to report the outcome of diagnostic arthroscopy of the wrist using a new tool, the NanoScope, under wide-awake local anesthesia with no tourniquet (WALANT). Patients and methodsThis was a prospective study of 30 consecutive patients with suspected ligament tear after wrist trauma and remaining symptoms after initial conservative management. All patients had an MRI prior to the NanoScope procedure. ResultsThe patients comprised 17 men and 13 women, with a mean age of 31 years. One patient declined the NanoScope procedure following their MRI. In the remaining 29 patients, NanoScope wrist arthroscopy revealed 19 cases of triangular fibrocartilaginous complex (TFCC) tears and 11 tears of the scapholunate (SL) or lunotriquetral (LT) ligaments. The correlation between preoperative MRI and the findings from NanoScope arthroscopy was poor. Six patients had additional surgery after the NanoScope arthroscopy, comprising three TFCC sutures, one SL and one LT ligament reconstruction respectively, and one wrist arthrodesis. No complications related to the NanoScope arthroscopies were noted. ConclusionNanoScope arthroscopy of the wrist is safe, is well-suited for surgery in WALANT, and has superior diagnostic capacity compared to MRI. Further studies are warranted to determine the role of the NanoScope in the management of wrist ligament pathologies. Level of evidenceThis is a level 4 study.

Current concepts and new trends in management of isolated triangular fibrocartilage complex injuries.

The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex.Level of evidence: V.

Diagnostic test performance of Amsterdam wrist rules in diagnosing wrist fracture in adults with wrist trauma

Abstract:&#x0D; Objective: Wrist trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam wrist rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for wrist fracture diagnosis. This study assessed the diagnostic test performance of this rule in wrist trauma for wrist fracture.&#x0D; Methods: All patients over 18 years old with the chief complaint of acute wrist trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of wrist fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist.&#x0D; Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (33.2%) patients with a wrist fracture, which distal radius accounted for most of them. The AWR had sensitivity and specificity of 0.71 (95% CI: 0.49,0.87) and 1 (95% CI: 0.92,1), respectively. Although the negative likelihood ratio of AWR was 0.29 (95% CI: 0.16,0.54), the positive likelihood ratio was infinite. The positive predicted value was 1 (95% CI: 0.80,1), whereas the negative predictive value was 0.86 (95% CI: 0.74,0.94).&#x0D; Conclusion: The AWR showed great specificity and positive predictive. It had fair sensitivity, negative predictive value, and negative likelihood ratio for diagnosis of wrist fracture in patients with wrist trauma.

The Effect of Radial Inclination on the Stage of Kienbock Disease at the Time of Initial Diagnosis.

Negative ulnar variance is a widely accepted risk factor for the development of Kienbock disease (KD). Variation in radial inclination has been proposed as a risk factor, but evidence thus far has been inconclusive. We aim to clarify the relationship between radial inclination and KD. A retrospective analysis of all KD patients from a single institution from 2007 to 2021 was conducted. Radiographs were reviewed to measure anatomic parameters and stage of disease. An exploratory multinomial regression model was created to examine the association of patient age, radial height, ulnar variance, radial inclination, volar tilt, scapholunate angle, duration of symptoms prior to evaluation, history of wrist trauma, and diagnosis of diabetes with stage of disease. Fifty-seven cases of KD were identified, with a mean duration of disease of 33.3 months. A history of trauma to the wrist was common (53%) and significantly associated with stage of disease at initial presentation. Twenty-seven cases (47%) were stage IIIB or greater. The average initial radial inclination, radial height, and ulnar variance was 21.9°, 10.7 mm, and -1.23 mm, respectively. A multinominal logistic regression model revealed decreased initial radial inclination is associated with Lichtman stage IIIB or greater at the time of initial patient presentation. A correlation exists between decreased radial inclination and more advanced KD at presentation, suggesting this may be a risk factor for disease progression. This correlation is strengthened by our finding of decreased ulnar variance being associated with later stage at presentation, which is one of the most widely accepted proposed risk factors for development and progression of disease. IV.

Volar Lunate Dislocation: A Case Report

Introduction: Perilunate dislocations are rare high-energy injuries which may often have the potential to cause lifelong disability of the wrist if not addressed optimally. Hence, early recognition, diagnosis, and intervention are of paramount importance in the restoring function and prevention of morbidity. Lunate dislocations are the fourth and last stage of perilunate dislocations being extremely rare, with volar dislocations representing &lt;3% of perilunate dislocations. Case Report: A 24-year-old man suffered from an alleged history of fall from a bike on an outstretched hand following which he developed complaints of pain and swelling in the right wrist. On examination, the patient has relative sensory loss over the lateral half of the palm with no vascular deficit. An accurate range of motion could not be documented due to severe pain. Standard digital X-rays revealed lunate displaced and angulated volarly with a typical “spilled teacup” appearance along with radial and ulnar styloid fractures. Management: The patient was initially given an attempt of closed reduction which was not successful and was followed with open reduction and internal fixation with both volar and dorsal approach with Kirschner wires. The patient’s wrist was immobilized for 6 weeks with below elbow cast with the removal of k wires at 8 weeks after which wrist ROM exercises were started. Results: The patient was followed up for 6 months and now has a functional range of motion of the wrist with no sensory deficit and is able to continue with his profession as a car mechanic. Conclusion: Mayfield progression Stage 4 perilunate dislocations are uncommon with a poor prognosis if not addressed timely. Hence, these injuries need to be identified early and optimally managed with surgical intervention for a favorable outcome. Keywords: Perilunate dislocation, carpal bones, avascular necrosis of lunate, wrist trauma, carpal instability

Urgent Distal Carpectomy Following Traumatic Wrist Injury: A Case Report

Urgent Distal Carpectomy Following Traumatic Wrist Injury: A Case Report

Volar Plate-Suture Fixation in the Treatment of Volar Rim Fractures of the Distal Radius

Abstract Background The purpose of this study was to describe the volar plate-suture fixation technique for augmented repair of volar rim fractures of the distal radius and to report clinical outcomes and radiographic findings. Patients and Methods Twenty-one patients treated with volar plate-suture fixation were retrospectively reviewed. Outcomes of interest included pain, joint motion, grip strength, surgical complications, additional surgeries, and radiographic parameters. Results Final follow-up office visits from surgery averaged 30.8 weeks (range 6–175 weeks). There was no report of residual wrist pain in most cases. Forearm and wrist motion measurements were within functional ranges and grip strength measurements averaged 63 ± 21% of the contralateral hand. There were no cases of infection, wound dehiscence, nerve injury, or nonunion. Hardware removal was performed in four patients for wrist pain attributed to the fixation implant(s). One patient underwent a wrist fusion for treatment of painful traumatic wrist arthritis. Failure of the fracture fixation construct to hold the carpus occurred in two patients. Changes in radiocarpal and intercarpal angles averaged less than 4 degrees and loss of articular reduction averaged less than 1 mm, although with relatively high standard deviations. Conclusion Suture fixation of volar rim fractures of the distal radius may be a useful technique in augmenting volar plate fracture fixation. Some loss of early postoperative fracture alignment should be expected. Level of Evidence IV, case series.

Fracture detection in pediatric wrist trauma X-ray images using YOLOv8 algorithm

Hospital emergency departments frequently receive lots of bone fracture cases, with pediatric wrist trauma fracture accounting for the majority of them. Before pediatric surgeons perform surgery, they need to ask patients how the fracture occurred and analyze the fracture situation by interpreting X-ray images. The interpretation of X-ray images often requires a combination of techniques from radiologists and surgeons, which requires time-consuming specialized training. With the rise of deep learning in the field of computer vision, network models applying for fracture detection has become an important research topic. In this paper, we use data augmentation to improve the model performance of YOLOv8 algorithm (the latest version of You Only Look Once) on a pediatric wrist trauma X-ray dataset (GRAZPEDWRI-DX), which is a public dataset. The experimental results show that our model has reached the state-of-the-art (SOTA) mean average precision (mAP 50). Specifically, mAP 50 of our model is 0.638, which is significantly higher than the 0.634 and 0.636 of the improved YOLOv7 and original YOLOv8 models. To enable surgeons to use our model for fracture detection on pediatric wrist trauma X-ray images, we have designed the application “Fracture Detection Using YOLOv8 App” to assist surgeons in diagnosing fractures, reducing the probability of error analysis, and providing more useful information for surgery.

ACUTE CARPAL TUNNEL SYNDROME: RESULTS OF A PROTOCOL FOR EARLY NERVE DECOMPRESSION AND SURGICAL STABILIZATION FOR BONY WRIST TRAUMA

We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours.We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing.The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up.We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours.