Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Abstract

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

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

“…On the other hand, our results reported that VT was even more predictive with an odds ratio of 45. This was in agreement with the study conducted by Kim et al [ 17 ] in which VT and tear drop angle (TDA) were significant independent predictors of development of DCTS.…”

Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

“…The delayed carpal tunnel syndrome in the elderly population was seen in cases where radiologically the VT and TDA were reduced. These were also important radiological parameters to correct the deformity in geriatric patients [13]. The meta-analysis of a comparative study of surgical and conservative treatment by Gutiérrez-Espinoza et al [14] proved the fact that extra-articular fractures had good functional outcomes with nonoperative treatment and surgical treatment with volar locking plates in displaced and partial articular or intraarticular fractures had better outcome and early returned to function.…”

What’s New in Hand and Wrist Surgery

“…Of 216 patients treated nonoperatively, 26 (12%) developed subacute CTS. In comparing patients who developed CTS with those who did not, the authors found an association with decreasing volar tilt (mean, 11.1° dorsal tilt compared with 0.1° volar tilt) and decreasing teardrop angle (mean, 48.7° compared with 63.0°) 32 on radiographs in those who developed CTS. The mean time to diagnosis of CTS was nearly 3 months (89.9 days), a time after which many patients have been discharged from care.…”