Correlation between delayed carpal tunnel syndrome and carpal malalignment after distal radial fracture

1. Anatomic alteration of the carpal tunnel in conservatively managed distal radius fractures (DRF), particularly diminished radio capitate distance (RCD), volar prominence height (VPH), and volar tilt (VT), is significantly associated with delayed carpal tunnel syndrome (DCTS) development.

Evidence Rating Level: 3 (Average)

Carpal tunnel syndrome (CTS) is a common complication following DRF. CTS development after DRF may present acutely (at the time of injury) or in a delayed fashion (after several weeks). DCTS, which has an incidence of 0.5 – 22%, is thought to occur due to anatomical changes in the carpal tunnel after fracture healing. This retrospective case-control study aimed to explore the association between changes in carpal alignment and the severity of median nerve entrapment in patients who underwent conservative management for their DRFs. The study included 60 female patients with a history of DRF in the last 6 months, half with symptoms congruent with DCTS — the symptomatic group — and the other half representing the control group. Both groups were comparable with regards to age and body mass index. Quantitative analysis of radiographic parameters, including the RCD, VPH, and VT, and electrophysiological evaluation of the median nerve was performed. The average time from injury to the onset of DCTS was 3 months, ranging from 7 weeks to 6 months. In the symptomatic group, approximately 46% had mild CTS, 23% had moderate CTS, and one patient had severe CTS. In comparison, the control group only had two patients with minimal abnormalities in electrophysiology of the median nerve (minimal CTS). RCD, VPH, and VT in the symptomatic group were − 11.48 mm, 2.24 mm, and − 20.68° angle, respectively. These radiograph parameters of carpal tunnel anatomy were significantly lower in the symptomatic group as compared with the controls. Overall, the study findings suggest that the risk and severity of DCTS are associated with poor distal radius alignment according to the radiologic features of RCD, VPH, and VT. Understanding these risk factors for the development of DCTS can inform surgeons regarding the optimal management of DRF. Despite highly significant results, this study is limited by the small sample size and inclusion of exclusively female patients over the age of 60, therefore future studies should amend these issues. 

Click to read the study in JOSR

Image: PD

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