Median nerve injuries associated with distal radius fractures

Median nerve dysfunction associated with distal radius fractures may present acutely, subacutely, or late, and may also be thought of as being from either primary or secondary causes. Primary nerve injuries are rare and secondary factors are more commonly responsible for median nerve dysfunction following distal radius fractures. Secondary factors may include bleeding, fracture displacement, and swelling, as well as the position of the wrist in the cast, splint, or external fixator. Careful inspection and examination of the patient at the time of injury is critical to identify median nerve dysfunction. In cases of identified dysfunction related to secondary factors, prompt intervention [reduction, carpal tunnel release (CTR)] is likely to yield an excellent outcome while the outcome of primary injury (in the absence of other extrinsic factors) is more related to the degree of the initial insult. Serial examination of sensibility, pain, and thenar muscle function is paramount. Measurement of carpal tunnel pressure may be helpful but does not negate physical examination findings. Controversy remains over whether prophylactic CTR is necessary after volar plating of distal radius fractures. There is incomplete data regarding this issue, but thus far, it would appear that routine prophylactic carpal tunnel is not necessary. Patients with a preinjury carpal tunnel syndrome, symptoms of median nerve dysfunction or those that have higher energy injuries that may be difficult to monitor postoperatively, are perhaps better candidates for concomitant carpal tunnel release.