Beneath the Surface: Prophylactic Carpal Tunnel Release Cuts Carpal Tunnel Syndrome Risk Post Volar Plating

Carpal tunnel syndrome (CTS) is a recognized complication following distal end radius fractures, particularly when managed surgically using volar locking plates. The pathophysiology involves post-traumatic edema, hematoma formation, or surgical manipulation leading to median nerve compression. This study compares the incidence of CTS and functional outcomes between patients treated with volar plating alone and those undergoing simultaneous carpal tunnel release (CTR).

A prospective observational study was conducted on 34 patients with distal radius fractures, evenly divided into two groups: Group A underwent open reduction and internal fixation (ORIF) with prophylactic CTR, and Group B received ORIF alone. Patients were assessed clinically and electrophysiologically using electromyogram/nerve conduction velocity for CTS symptoms at 3 and 6 months postoperatively. Functional recovery was evaluated using the patient-rated wrist evaluation (PRWE) score. Post-operative complications were also recorded.

At 3 months, CTS symptoms were present in five patients in Group A and seven patients in Group B. At 6 months, only two patients in Group A exhibited symptoms, whereas the number rose to 10 in Group B. Group A showed fewer complications, including nerve irritation (2 vs. 7), tendon irritation (3 vs. 5), infection (2 vs. 4), and plate loosening (1 vs. 2). PRWE scores were consistently better in Group A.

Prophylactic CTR at the time of volar plating for distal radius fractures appears to significantly reduce the incidence of post-operative CTS and improve functional outcomes without increasing complication rates. These findings support the role of early median nerve decompression in select cases.