Volar Plate Osteosynthesis of Distal Radius Fractures With Concurrent Prophylactic Carpal Tunnel Release Using a Hybrid Flexor Carpi Radialis Approach

Loss of median nerve function or a neuropathic pain syndrome may occur in around 20% of distal radius fractures if post-traumatic oedema in the carpal canal generates excessive pressure on the median nerve. No method currently exists to reliably distinguish which patients may benefit from a concomitant carpal tunnel release. This case series details the results of following a prospective plan designed to minimise median nerve related complications associated with distal radius fractures by measuring Semmes-Weinstein monofilament scores in 374 radius fracture patients who underwent surgical stabilisation. One hundred and sixty-nine patients with the clinical symptoms of median nerve compression, a decrement in monofilament score of grade 1 (out of 5) compared to the contralateral side or at least 4.31 g underwent concomitant carpal tunnel release. The remaining 205 patients did not have carpal tunnel release. There were no cases of neuropathic pain or loss of median nerve function.

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Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

Injury ◽

10.1016/s0020-1383(17)30654-x ◽

2017 ◽

Vol 48 ◽

pp. S30-S33 ◽

Cited By ~ 1

Author(s):

Antonio Medici ◽

Luigi Meccariello ◽

Giuseppe Rollo ◽

Giancarlo De Nigris ◽

Steven James Mccabe ◽

...

Keyword(s):

Distal Radius ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Distal Radius Fractures ◽

Radius Fractures

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Carpal Canal Pressures after Volar Plating of Distal Radius Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.10.013 ◽

2006 ◽

Vol 31 (2) ◽

pp. 236-239 ◽

Cited By ~ 19

Author(s):

D. A. FULLER ◽

M. BARRETT ◽

R. K. MARBURGER ◽

R. HIRSCH

Keyword(s):

Distal Radius ◽

Carpal Tunnel ◽

Research Study ◽

Carpal Tunnel Release ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Elevated Pressures ◽

Nerve Dysfunction ◽

Peak Pressures

Elevated pressures within the carpal canal are known to occur after distal radius fractures. Controversy exists regarding prophylactic carpal tunnel release after open reduction with internal fixation of distal radius fractures. The purpose of this study was to determine the tissue pressures within the carpal canal after volar plating of distal radius fractures. This study was a prospective, observational, IRB approved research study. Ten consecutive patients undergoing volar plating of distal radius fractures were enrolled. After the distal radius fractures were reduced and fixed with volar plates, slit catheters were inserted into the carpal canals for continuous postoperative pressure monitoring for 24 hours. The maximum recorded pressure was 65 mmHg, which occurred in the only patient with fracture blisters. Peak pressures remained at 40 mmHg or less (range 16–40, mean 29) in all patients without fracture blisters. At the conclusion of data collection, all pressures were at 31 mmHg or less. No patient complained of median nerve dysfunction during the study period. Routine prophylactic carpal tunnel release is not recommended after volar plating of distal radius fractures based on these pressure recordings.

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Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413476418 ◽

2013 ◽

Vol 38 (7) ◽

pp. 751-757 ◽

Cited By ~ 15

Author(s):

I. Mehling ◽

P. Rittstieg ◽

A. P. Mehling ◽

R. Küchle ◽

L. P. Müller ◽

...

Keyword(s):

Distal Radius ◽

Plate Osteosynthesis ◽

Three Dimensional ◽

Exposure Dose ◽

Ct Imaging ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Radiation Exposure Dose ◽

Volar Plate Osteosynthesis

The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and correction was done immediately. C-arm CT imaging can easily be integrated in the normal course of surgery. As a complement to the standard 2D-fluoroscopy, the C-arm CT is a useful tool to evaluate the quality of osteosynthesis.

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The Value of Carpal Tunnel Release in Conjunction with Volar Plating of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(11)60009-9 ◽

2011 ◽

Vol 36 (8) ◽

pp. 8

Author(s):

William D. Lanzinger ◽

Randip R. Bindra ◽

Cari Lee Cordell ◽

Michael S. Bednar ◽

Terry R. Light

Keyword(s):

Distal Radius ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures

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Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x12851639107151 ◽

2011 ◽

Vol 93 (1) ◽

pp. 57-60 ◽

Cited By ~ 14

Author(s):

DC Perry ◽

DMG Machin ◽

JA Casaletto ◽

DJ Brown

Keyword(s):

High Risk ◽

Distal Radius ◽

Plate Fixation ◽

Tendon Injury ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Extensor Pollicis Longus ◽

Fixed Angle ◽

Volar Plate Fixation

INTRODUCTION Rupture of extensor pollicis longus (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific ‘high-risk’ holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of ‘high-risk’ holes and appropriate minor alterations in surgical technique may consequently decrease the incidence of EPL irritation and rupture.

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