Incidence of Posttraumatic Carpal Tunnel Syndrome After Perilunate Injuries

Perilunate injuries are a spectrum of high-energy carpus injuries with significant long-term sequelae and generally poor outcomes. Posttraumatic carpal tunnel syndrome (CTS) is an established sequela of these injuries, although its incidence varies widely in literature. This study aims to evaluate the risk of posttraumatic CTS after these injuries and contrast between nonoperative and operative perilunate injuries.

The TriNetX database was queried for all patients treated for either closed or open management of a perilunate injury between January 1, 2010, and December 31, 2023. Operative and nonoperative injuries were defined by inclusion/exclusion of their corresponding Current Procedural Terminology (CPT) codes. Posttraumatic CTS was evaluated using International Classification of Diseases codes and carpal tunnel releases (CTRs) tracked using CPT codes. Relative risk and odds ratios were used to assess differences between nonoperative and operative cohorts.

A total of 5,167 perilunate injuries were included in this study. Of these, 2715 (52.5%) underwent nonoperative management, whereas 2,452 (47.5%) received surgical stabilization. Among patients treated nonoperatively, 93 (3.4%) were diagnosed with CTS within 1 year, with 98 (3.6%) requiring CTR. Among operative patients, 565 (23%) were diagnosed with CTS within 1 year of their injury, while 927 operative patients (37.8%) underwent CTRs. Conservatively managed perilunate injuries were at less risk for developing CTS or undergoing CTRs.

Approximately 13% of perilunate injuries were associated with CTS within 1 year of treatment. Patients treated operatively were diagnosed with CTS approximately 7 times as frequently and underwent CTR more than 10 times more frequently than their nonoperative counterparts.