Surgical Decision Making in Median Neuropathy Associated With Distal Radius Fractures
Sezai Özkan, MD1; Frank W Bloemers, MD, PhD2; Brady T Evans, MD, MBA1; Colyn J Watkins, MD1, Marilyn Heng, MD1; Chaitanya Mudgal, MD1
1Massachusetts General Hospital/Harvard Medical School, Boston, MA; 2VU University Medical Center, Amsterdam, Netherlands
INTRODUCTION: A lack of conclusive evidence on the treatment of Acute Carpal Tunnel Syndrome (ACTS) in patients with distal radius fractures has led to inconsistent surgical guidelines and recommendations regarding ACTS in distal radius fractures. There is a wide variation in surgical decision making. We aimed to evaluate international differences between surgical considerations and practices related to carpal tunnel release in the setting of distal radius fractures.
METHODS: We approached surgeons who were a member of the Orthopaedic Trauma Association (USA) or of the Dutch Trauma Society (the Netherlands) and asked them to provide sociodemographic information and information on their surgical practice regarding carpal tunnel release in the setting of distal radius fractures. After applying our exclusion criteria, our final cohort consisted of 127 respondents (Table 1).
RESULTS: Compared to Dutch surgeons, surgeons from the USA are more of the opinion that displaced distal radius fractures are at risk of developing ACTS, consider persistent paresthesia in the median nerve distribution after closed reduction to be a surgical emergency less often (Table 2), and are more likely to perform a CTR if there are signs of ACTS in the setting of a distal radius fracture (Table 3).
CONCLUSION: A lack of conclusive evidence has led to international differences in surgical practice regarding the treatment of ACTS in the setting of distal radius fractures. Future research should guide surgeons in making appropriate evidence-based decisions when performing CTR in the setting of distal radius fractures.
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