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Predicting Acute Median Neuropathy in Perilunate Injuries.

Thomas John Carroll¹, Mina Botros¹, Richard Lander¹

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

Journal of Hand Surgery Global Online

|February 5, 2024

Summary

This summary is machine-generated.

Perilunate fracture dislocations (PLFD) often lead to carpal tunnel syndrome (CTS). Over half of patients with PLFD not undergoing carpal tunnel release (CTR) initially eventually require it, indicating its importance in managing PLFD.

Keywords:

Carpal tunnel release Carpal tunnel syndrome Dislocation Lunate Perilunate

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Area of Science:

Orthopedic Surgery
Trauma Surgery
Hand Surgery

Background:

Perilunate fracture dislocation (PLFD) is a severe wrist injury.
Acute carpal tunnel syndrome (CTS) is a known complication of PLFD.
Identifying risk factors for CTS in PLFD is crucial for timely intervention.

Purpose of the Study:

To determine factors predicting CTS development in PLFD patients.
To classify PLFD patients who require delayed carpal tunnel release (CTR).

Main Methods:

Retrospective review of 43 patients with isolated PLFD (Mayfield III-IV) at a level-1 trauma center.
Exclusion of polytraumatized patients and those with prior wrist issues.
Analysis of CTS development, pre/post-reduction symptoms, and associated fractures using chi-square, Kruskal-Wallis, and logistic regression.

Main Results:

26% of patients presented with acute CTS, increasing to 28% post-reduction.
No significant correlation between time to reduction and acute CTS presence.
79% underwent immediate CTR; 57% of those not receiving immediate CTR required it later.

Conclusions:

Reduction of PLFD does not significantly alter the incidence of acute CTS.
A high rate (over 50%) of patients with PLFD not undergoing immediate CTR eventually require it, highlighting the need for careful consideration of early intervention.