Acute carpal tunnel syndrome as first presentation of amyloidosis: a case report

N/A - Case Report

Point Blank: A Retrospective Review of Self-inflicted Gunshot Wounds to the Hand

Background A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non–self-inflicted (NSI) GSWs. Methods We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018. Results We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, P = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, P = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, P = .08). Conclusions Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.

The rate and associated risk factors for acute carpal tunnel syndrome complicating a fracture of the distal radius

Background Acute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius. Methods A retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS. Results There were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS. Conclusion Four percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented. Level of evidence: III.

543 Acute Carpal Tunnel Syndrome from a Solar Panel Electrical Injury: A Case Report and Literature Review

Introduction The utilization of solar panels for residential and industrial purposes is increasing. Electrical injury from solar panels has not been well defined. Most of the literature on electrical burns is predominately from alternating current (AC) injuries instead of direct current (DC) as seen in solar panels. The implication of solar panel electrical injury in the pathogenesis of acute carpal tunnel syndrome has yet to be reported. Methods A retrospective chart review of a patient presenting to our burn unit following a solar panel electrical injury was performed. Results The patient was a 46 year old otherwise healthy male who presented after 5–10 seconds of high voltage (~7500V) direct current injury to his right forearm. The patient had deep partial thickness burns to his right hypothenar eminence and a full thickness defect with exposed muscle on his right volar forearm. On admission he had complete function, but within hours developed an inability to move his hand. He was taken for exploration on hospital day 2 because of mildly elevated compartment pressures, pain, and paresthesia. The hypothenar injury was noted to have converted to full thickness injury and a distal right volar forearm fasciotomy and carpal tunnel release was performed. On hospital day 3, the patient’s pain and neurologic examination improved. At 3 month follow-up, the patient had some restored function of his hand, but reduced grip strength, and mild persistent pain and paresthesia in the volar wrist and hand. Conclusions Solar panel injuries are expected to rise. The use of high voltage direct current energy has the potential to cause serious harm and appropriate awareness can lead to thorough management and better outcomes of burn victims. With electrical injuries to the hand, providers should have a low threshold for carpal tunnel syndrome, whose symptoms may be complicated by concomitant compartment syndrome of the hand and/or forearm. Lastly, as with most burn injuries a multidisciplinary approach should be established with focus on long term care. Applicability of Research to Practice We suspect that this new etiology of electrical burn is on the rise as we see more solar panels being utilized. Physician should be familiar with potential complications in this complex patient population.