Secondary Carpal Tunnel Release After Surgical Fixation of the Distal Radius: A Case-Control Study

Carpal tunnel syndrome (CTS) may occur after surgical fixation of a distal radius fracture (DRF) and can result in muscle atrophy and permanent nerve damage if untreated. Despite increased surgical treatments for DRFs, the frequency and risk factors for secondary carpal tunnel release (CTR) after DRF fixation remain unclear. This study aims to identify the frequency of secondary CTR after DRF fixation and factors associated with secondary release.

Adult patients who underwent either a secondary CTR within 1 year after surgical fixation of the DRF (secondary release case group) or a concomitant CTR (concomitant release control group) between 2001 and 2023 were identified. Secondary release cases were matched 1:4 to concomitant release controls. Patient, diagnosis, and treatment characteristics were collected and analyzed. Multivariable logistic regression using backward selection was performed to identify risk factors for secondary CTR.

Of 6612 surgically treated DRFs, 77 patients (1.2%) underwent secondary release within the first year, and 948 patients (14.3%) underwent concomitant release. Nerve compression symptoms before initial surgical fixation of the DRF were observed in 26 patients (33.8%). Multivariable logistic regression revealed that hypothyroidism and osteoporosis were statistically significant predictors for secondary CTR after surgical fixation of the DRF. The scores of Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Reported Outcomes Measurement Information System (PROMIS)-Upper Extremity were clinically similar for both groups of patients.

Of all patients undergoing CTR within 1 year of DRF fixation, 92.5% underwent concomitant release, and 7.5% underwent secondary release. Patients diagnosed with hypothyroidism or osteoporosis were significantly more likely to undergo a secondary surgery for CTR.