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Acute Median Neuropathy and Carpal Tunnel Release in Perilunate Injuries Can We Predict Who Gets a Median Neuropathy?

Abstract

This study addressed the following null hypotheses: 1) There are no demographic differences between patients with perilunate dislocation (PLD) or fracture-dislocation (PLFD); 2) There are no factors associated with the development of median nerve symptoms in the setting of a PLD or PLFD; and 3) There are no factors associated with carpal tunnel release. Using a retrospective search of a prospective trauma database, we identified all patients who had sustained a radiologically confirmed PLD or PLFD over a 10-year period at two trauma centers. From the medical records we identified median nerve symptoms and carpal tunnel release in addition to demographic and injury characteristics. Among the 71 patients treated for PLD or PLFD, acute median neuropathy was diagnosed in 33 patients (47 %). The only significant difference between PLD and PLFD was a younger age with PLFD. No demographic or injury factors were associated with symptoms of median neuropathy. Carpal tunnel release surgery during the initial operative management was related to the presence of median nerve symptoms and the trauma center. We report a high incidence of acute median neuropathy accompanying perilunate injuries. As there are no demographic or injury factors associated with symptoms of median neuropathy; all patients with PLD/PLFD merit equally high vigilance for acute median neuropathy.

Level of Evidence: Level III, prognostic study

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Compliance with Ethical Standards

Conflict of Interest Statement

No author has any conflict of interest directly related to the work under consideration for publication.

Relevant Financial activities outside the submitted work

DR has a consultancy with Wright Medical and Skeletal Dynamics. He also gives expert testimony in malpractice and personal injury lawsuits. His institution has grants pending with Biomet and Skeletal Dynamics. He is paid to give lectures by AO North America, AO International and multiple universities. He receives royalties from Wright Medical, Skeletal Dynamics, Medartis, and Biomet. He has stock in Iluminos. He is Parliamentarian for Hand, Deputy Editor of The Journal of Hand Surgery, Deputy Editor of The Journal of Orthopaedic Trauma, Associate Editor of The Journal of Shoulder and Elbow Surgery and Deputy Editor of Clinical Orthopaedics and Related Research.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that the appropriate ethical reviews have occurred and we enclose documentation proving this.

Location of work

The work was performed both at The Royal Infirmary of Edinburgh and Massachusetts General Hospital.

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Correspondence to Neil R. Wickramasinghe.

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Wickramasinghe, N.R., Duckworth, A.D., Clement, N.D. et al. Acute Median Neuropathy and Carpal Tunnel Release in Perilunate Injuries Can We Predict Who Gets a Median Neuropathy? . J Hand Microsurg 7, 237–240 (2015). https://doi.org/10.1007/s12593-015-0189-z

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Keywords

  • Perilunate dislocations
  • Perilunate fracture-dislocations
  • Epidemiology
  • Median neuropathy
  • Carpal tunnel release