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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Meidan Nerve Conduction Velocity after Distal Radius Fracture Fixation with a Volar Locked Plate
Stephen Y. Liu, MD1; Gabriella DiBernardo, BS1; Kia M. Washington, MD2; Robert J. Goitz, MD3; John R. Fowler, MD3; (1)University of Pittsburgh, Pittsburgh, PA, (2)McGowan Institute for Regenerative Medicine, Pittsburgh, PA, (3)Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Purpose: To determine median nerve conduction velocity delay in patients after distal radius fracture and the impact operative fixation with a volar locking plate has on these findings. We hypothesized that a significant percentage of patients would have nerve conduction evidence of carpal tunnel syndrome after initial injury and that surgical fixation with a volar plate would have a minimal impact on median nerve latencies.

Methods: This is a prospective cohort study of fourteen asymptomatic patients that underwent treatment of a distal radius fracture with a volar locking plate. All patients were operated on within 2-weeks of injury. On the day of surgery and at the 6-week follow-up, patients were evaluated via clinical exam, quickDASH, and a nerve conduction study using a hand-held device ADVANCED-NCS (NeuroMetrix;Waltham, MA). Nerve conduction velocities of the contralateral limb at the 6-week visit were used as a baseline. Pre-operative and post-operative nerve function was compared to baseline using a 2-tailed student t-test. The latency values were assessed for correlation to the quickDASH using the Pearson coefficient. Significance was set to p < 0.05.

Results: Asymptomatic patients after distal radius fracture have a 28% incidence carpal tunnel syndrome as defined by median distal sensory latency. Distal sensory latencies of the median nerve were 3.64 0.32ms at baseline, 3.761 0.70ms after fracture, and 3.81 0.52ms post-operatively. Distal motor latencies of the median nerve were 3.91 0.59ms, 3.60 0.68, and 3.88 .36ms at respective time points. There was no significant difference between baseline, pre-operative, and post-operative median nerve latencies. Patient QDASH scores improved from an average of 77 to 46 points in the 6-weeks they were followed. QDASH scores showed weak correlation, r = 0.091-0.166, to NCV latencies.

Conclusions: There is a subset of asymptomatic patients that will have nerve conduction velocities diagnostic of carpal tunnel syndrome after distal radius fracture. Surgical fixation with a volar locked plate in our series did not prolong median nerve latency across the wrist and no patient required carpal tunnel release post-operatively.

Level of Evidence: Prognostic level II.


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