Median Nerve Injuries Associated With Distal Radius Fractures

Purpose: During volar plate fixation of distal radius fractures, we have encountered patients with an anomalous course of the palmar cutaneous branch (PCB) of the median nerve within the sheath of the flexor carpi radialis (FCR) tendon. The purpose of this study was to assess the frequency and location of variations of the PCB within the sheath of the FCR tendon.Methods: This retrospective study enrolled 83 patients who underwent volar locking plate fixations through a modified Henry approach for distal radius fractures from July 2018 to April 2020. When we encountered an anomalous PCB within the sheath of the FCR tendon, we documented the specific finding and location where the PCB entered the sheath of the FCR tendon.Results: There were nine patients (10.8%) who had an anomalous course of PCB penetrating the sheath of the FCR tendon. The average entering point of PCB into the sheath of the FCR tendon was 3.07 cm from the distal wrist crease (range, 2.5–3.6 cm).Conclusion: An anomalous course of the PCB entering the sheath of the FCR tendon was observed at a high frequency (10.8%). Care must be taken not to injure the PCB during a dissecting of the FCR sheath during a modified Henry approach for a distal radius fracture.

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A PROSPECTIVE PLAN TO MINIMISE MEDIAN NERVE RELATED COMPLICATIONS ASSOCIATED WITH OPERATIVELY TREATED DISTAL RADIUS FRACTURES

Hand Surgery ◽

10.1142/s021881040700364x ◽

2007 ◽

Vol 12 (03) ◽

pp. 199-204 ◽

Cited By ~ 14

Author(s):

Mark Henry ◽

Christopher Stutz

Keyword(s):

Neuropathic Pain ◽

Median Nerve ◽

Distal Radius ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Case Series ◽

Distal Radius Fractures ◽

Nerve Function ◽

Radius Fractures ◽

Neuropathic Pain Syndrome

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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Anomalous Courses of the Palmar Cutaneous Branch of the Median Nerve in Relation to the Flexor Carpi Radialis Tendon for ORIF of Distal Radius Fractures

Hand ◽

10.1177/1558944718825137 ◽

2019 ◽

Vol 15 (4) ◽

pp. 521-525

Author(s):

Steven Z. Glickel ◽

Sara M. Glynn ◽

Andy L. Chang ◽

Jessie W. Janowski ◽

O. Alton Barron ◽

...

Keyword(s):

Median Nerve ◽

Distal Radius ◽

Tendon Sheath ◽

Distal Radius Fractures ◽

Final Decision ◽

Radius Fractures ◽

Flexor Carpi Radialis ◽

Palmar Cutaneous Branch ◽

Branching Patterns ◽

Cutaneous Branch

Background: The purpose of this study was to prospectively document the incidence of variations in the course of palmar cutaneous branch of the median nerve (PCBMN) that may increase the risk of injury to the nerve during the flexor carpi radialis (FCR) approach. We hypothesize that the incidence of anomalous branching of the PCBMN around the FCR sheath will be approximately 5%. Methods: All cases that met inclusion criteria between November 2013 and March 2018 were included. The operating surgeon made the final decision for operative intervention using the FCR approach. Each surgeon performed the standard FCR approach to the distal radius. The branching location from the median nerve, the relationship to the FCR sheath, and the course of the PCBMN were recorded. Results: In total, 101 distal radius fractures were included. The average branching point of PCBMN was 5.2 cm from the distal wrist crease (range = 3.3-9.0). There were 26 anomalous branching patterns of PCBMN. Nineteen (18.8%) crossed volar, dorsal, or ran within the FCR sheath. Six PCBMN were found within the FCR sheath, 1 penetrated the FCR sheath, 6 crossed volar to the FCR sheath, and 6 were dorsal to the FCR tendon sheath. When comparing the branching patterns of the PCBMN from the median nerve, 4 branched from the volar aspect, 2 branched from the dorsal aspect, and 1 branched from the ulnar aspect of the median nerve. Conclusions: Variation in the course of the PCBMN relative to the FCR sheath is more than previously thought and can be expected in approximately 18.8% of patients.

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Single Incision, Dual Window Approach for a Comminuted Distal Radius Fracture

Journal of Wrist Surgery ◽

10.1055/s-0041-1725961 ◽

2021 ◽

Author(s):

Arianna Gianakos ◽

Priya Patel ◽

Christian M. Athens ◽

John T. Capo

Keyword(s):

Median Nerve ◽

Distal Radius ◽

Single Incision ◽

Articular Surface ◽

Direct Reduction ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Ulnar Aspect ◽

Window Approach ◽

Dual Window

Abstract Introduction Complex distal radius fractures often involve a fragment of the volar-ulnar articular surface and the radial styloid. The volar ulnar corner of the distal radius is an important constraint to volar translation of the carpus and thus requires stable fixation to prevent wrist displacement. The traditional volar Henry approach often requires undue tension on the median nerve while retracting for access to the ulnar aspect of the radius. To protect the median nerve from iatrogenic injury and to improve exposure of the surgical site, we propose a single incision, dual window approach to the distal radius for complex bi-columnar fractures. Methods This technique combines the trans-Flexor Carpi Radialis (FCR) approach with a subcutaneous dissection to the ulnar aspect of the wrist. This window utilizes the interval between the ulnar neurovascular bundle and the carpal tunnel contents. Results This technique allows the surgeon to work through either window and thus visualize and directly fixate the various fracture fragments. We have treated complex articular distal radius fractures associated with ulnar communition with this novel technique and it has provided direct reduction with improved fragment access. The surgical technique, a case presentation and results are detailed in this report. Conclusion This case report has demonstrated that complex bi-columnar fractures of the distal radius can be effectively approached and fixated with a single incision dual window approach.

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