Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Abstract

Background: Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon's decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management.

Methods: We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author's office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non-carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses.

Results: The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified.

Conclusions: Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

Keywords: basic science; carpal tunnel syndrome; diagnosis; distal radius; evaluation; fracture/dislocation; nerve; nerve compression; research and health outcomes; trauma; wrist.

Figure 1.

Posterioanterior view of wrist. Note. Radial inclination—Angle between a line drawn from the tip of the radial styloid to the central reference point (B) and a line that is perpendicular (C) to the long axis of the radial shaft (A). Ulnar variance—Distance between 2 lines drawn perpendicular to a reference line extended along the axis of the radial shaft (A). One perpendicular line intersects the central reference point (C) and the other perpendicular line intersects the distal edge (D) of the ulnar head.

Figure 2.

Lateral view of wrist. Note. Teardrop angle—Angle between a line extended along the longitudinal axis of the radial shaft (A) and a line that is drawn down the center of the teardrop (B). Volar tilt—Angle between a line perpendicular to the central axis (D) of the radial shaft (A) and a line that connects the corner of the dorsal rim and the corner of the volar rim of distal radius (C).

Figure 3.

Lateral view of pre/post-manipulation of intra-articular distal radius fracture. Note. Lateral view of pre-manipulation of intra-articular distal radius fracture (a) demonstrating loss of volar tilt and decreased teardrop angle (TDA); and post-manipulation (b) demonstrating restoration of volar tilt to 6° with persistent decreased TDA of 54°.