Predicting Acute Median Neuropathy in Perilunate Injuries

Thomas John Carroll; Mina Botros; Richard Lander; Sophia Moody; Megan L Reitenbach; Danielle Wilbur

doi:10.1016/j.jhsg.2023.09.003

Predicting Acute Median Neuropathy in Perilunate Injuries

J Hand Surg Glob Online. 2023 Oct 10;6(1):58-61. doi: 10.1016/j.jhsg.2023.09.003. eCollection 2024 Jan.

Authors

Thomas John Carroll¹, Mina Botros¹, Richard Lander¹, Sophia Moody¹, Megan L Reitenbach¹, Danielle Wilbur¹

Affiliation

¹ University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY.

Abstract

Purpose: Perilunate fracture dislocation (PLFD) injuries are associated with the development of acute carpal tunnel syndrome (CTS). The purpose of our study was to identify the factors that increase the likelihood of developing CTS in patients with PLFD. Additionally, we attempted to classify patients who did not initially undergo carpal tunnel release (CTR) at the time of injury but eventually underwent CTR within the follow-up period.

Methods: Patients presenting to a level-1 trauma center with isolated PLFDs (Mayfield III-IV) were retrospectively identified by using CPT and ICD-10 codes. Polytraumatized patients, those with a history of previous wrist trauma, or those with previous carpal tunnel symptoms or surgery were excluded. Outcomes of interest included the development of acute CTS, pre- and post-reduction changes in CTS symptoms, and associated hand and wrist fractures. Chi-square tests, Kruskal-Wallis tests, and multivariate logistic regression were used to examine the predictors of developing CTS after a PLFD.

Results: In total, 43 patients were included in the final cohort, with a mean age of 44 years, of which 77% were men. The most common fracture of the carpus included scaphoid fractures (9/43, 21%). The average time from presentation to reduction was 636 minutes. Acute CTS symptoms before reduction were present in 26% of the patients and increased post-reduction to 28%. No difference exists between the time to sedation and the presence of acute carpal tunnel symptoms (P >.05). During initial surgical intervention, 79% underwent CTR (27/34). Of the seven patients who did not initially undergo a CTR, 57% (4/7) required a CTR within the follow-up period.

Conclusion: Reduction of PLFDs did not significantly improve the number of patients with acute CTS. More than 50% of the patients who did not undergo a CTR at the initial surgery required a CTR within the follow-up period.

Type of study/level of evidence: Prognostic III.

Keywords: Carpal tunnel release; Carpal tunnel syndrome; Dislocation; Lunate; Perilunate.