Predictors of Acute Carpal Tunnel Syndrome Associated With Fracture of the Distal Radius

Purpose A better understanding of the risk factors for acute carpal tunnel syndrome (CTS) associated with fracture of the distal radius might influence recommendations for prophylactic carpal tunnel release. Methods Fifty patients who had release of an acute CTS in association with open reduction and internal fixation (ORIF) of a fracture of the distal radius were identified from orthopedic trauma databases at 2 institutions. Each patient was matched with a control patient (ORIF, but no acute CTS) of the same gender, similar age (+/- 4 years), and similar injury mechanism. Results The prevalence of acute CTS among patients with a surgically treated fracture of the distal radius was 5.4%. In univariate analysis, only fracture translation was a significant predictor of acute CTS, but ipsilateral upper extremity trauma and status as a multitrauma patient were nearly significant. The best multivariate model included fracture translation alone and accounted for 60% of the observed increase in risk. A subgroup analysis using receiver operating characteristics (ROC) identified a threshold of approximately 35% fracture translation associated with a significantly increased risk of acute CTS in women less than 48 years of age. No threshold was identified in the other 3 subgroups. Conclusions Fracture translation is the most important risk factor for acute CTS in patients who subsequently had ORIF of a fracture of the distal radius. On the basis of these data, prophylactic carpal tunnel release might be appropriate in women less than 48 years of age with greater than 35% fracture translation, but further investigation is needed to confirm that a true threshold exists. (J Hand Surg 2008;33A:1309-1313. Copyright (C) 2008 by the American Society for Surgery of the Hand. All rights reserved.)