Carpal Tunnel Syndrome Following Corrective Osteotomy for Distal Radius Malunion: A Rare Case Report and Review of the Literature

Abstract

Background: Although median nerve neuropathy and carpal tunnel syndrome (CTS) are known complications of both untreated and acutely treated distal radius fracture, median neuropathy after correction of distal radius malunion is not commonly reported in hand surgery literature. We describe a patient with severe CTS after corrective osteotomy, open reduction internal fixation (ORIF) with a volar locking plate (VLP), and bone grafting for distal radius malunion.

Methods: We report a case of severe acute CTS as a complication of corrective osteotomy with bone grafting for distal radius malunion.

Results: The patient was treated with surgical exploration of the median nerve and carpal tunnel release.

Conclusion: The authors report a case of acute CTS after ORIF with VLP for a distal radius malunion warranting surgical exploration and carpal tunnel release. Treatment teams must be aware of this potential complication so that the threshold for reoperation is low and irreversible damage to the median nerve is prevented.

Keywords: carpal tunnel syndrome; corrective osteotomy; distal radius; malunion; median nerve.

Figure 1.

Preoperative posteroanterior radiograph demonstrating loss of radial height, loss of radial inclination, ulnar positive variance, and distal radius malunion.

Figure 2.

Preoperative lateral radiograph demonstrating volar subluxation of the carpus with loss of volar tilt and abnormal tear drop angle.

Figure 3.

Preoperative computed tomography scan demonstrating the volar Barton’s fracture with delineation of the volar shear fragment.

Figure 4.

Intraoperative fluoroscopic image demonstrating the use of laminar spreader to distract the distal fragment and restore the height of the radius.

Figure 5.

Intraoperative view demonstrating the course of the median nerve after full carpal tunnel release. It was found to be intact throughout its course but acutely compressed within the carpal tunnel.

Figure 6.

Two-month posteroanterior postoperative radiograph demonstrating restoration of radial height, radial inclination, and absence of ulnar positive variance. Radiograph demonstrate ongoing healing of bone graft with appropriate placement of hardware.

Figure 7.

Two-month postoperative lateral image demonstrates restoration of normal positioning of carpus as it relates to the volar cortex of the radius. Radiographs demonstrate ongoing healing of bone graft with appropriate placement of hardware.