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Median neuropathy in malunited fractures of the distal radius

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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Irritation of the median nerve is a well-characterized complication after acute fractures of the distal radius, but there is limited literature on median neuropathy in malunited fractures. The aims of our prospective study were to estimate the prevalence of the median neuropathy, explore the relationship between radiographic findings and the condition, and investigate whether corrective osteotomy without carpal tunnel release was a sufficient treatment.

Methods

Thirty consecutive patients, who were referred to us for treatment of symptomatic distal radial malunion, underwent nerve conduction studies of both wrists by one board-certified neurologist under standardized conditions. Test results were correlated with conventional radiographic parameters (radial tilt, radial inclination, palmar shift, ulnar variance, radiolunate and capitolunate angle) and computer tomography (CT) based measurements of the cross-sectional area of the carpal tunnel. After corrective osteotomy without carpal tunnel release, 10 of 13 patients with unilateral preoperative median neuropathy agreed to an electrodiagnostic re-examination by the same neurologist.

Results

Nineteen patients demonstrated abnormal test results, but only seven patients complained about paresthesias of median-innervated fingers. There was no correlation between median neuropathy and conventional radiographic parameters. Surprisingly, the cross-sectional area of the carpal canal was significantly greater for patients with median neuropathy. Symptoms resolved in all patients after corrective osteotomy. Postoperatively, six of ten patients demonstrated improved nerve conduction studies, although only four patients demonstrated normal test results.

Discussion

There is a high rate of subclinical median neuropathy in malunited distal radial fractures that cannot be predicted by conventional radiographic parameters. Corrective osteotomy without carpal tunnel release is a sufficient treatment for neuropathy in malunited distal radius fractures.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Clinic for Hand Surgery, Rhön-Klinikum, Bad Neustadt, Germany

    Kai Megerle, Jörg van Schoonhoven & Karl-Josef Prommersberger

  2. Clinic for Neurology, Rhön-Klinikum, Bad Neustadt, Germany

    Alfred Baumgarten

  3. Department of Diagnostic and Interventional Radiology, Rhön Klinikum, Bad Neustadt, Germany

    Rainer Schmitt

  4. Clinic for Plastic Surgery and Hand Surgery, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Kai Megerle

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  1. Kai Megerle
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  2. Alfred Baumgarten
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  3. Rainer Schmitt
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  4. Jörg van Schoonhoven
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  5. Karl-Josef Prommersberger
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Correspondence to Kai Megerle.

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Megerle, K., Baumgarten, A., Schmitt, R. et al. Median neuropathy in malunited fractures of the distal radius. Arch Orthop Trauma Surg 133, 1321–1327 (2013). https://doi.org/10.1007/s00402-013-1803-9

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  • DOI: https://doi.org/10.1007/s00402-013-1803-9

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