Prophylactic Carpal Tunnel Release During Volar Plating of Distal Radius Fractures: A Review.

Purpose: Patients who fracture their distal radius are at risk of developing carpal tunnel syndrome (CTS). Carpal tunnel syndrome occurs acutely; other patients may present with signs and symptoms of CTS weeks or months after the distal radius fracture. Because CTS may present in a delayed fashion after a distal radius fracture, some surgeons will perform carpal tunnel release (CTR) in patients who undergo open reduction and internal fixation even in those patients who do not have clinical evidence of CTS-a prophylactic CTR. In the current systematic review, we evaluated the literature regarding prophylactic CTR in the setting of surgical treatment of distal radius fractures. Methods: We conducted our literature review based on the preferred reporting items for systematic reviews and meta-analyses guidelines. The search strategy reflected "prophylactic CTR during treatment of distal radius fractures" and was conducted in February 2024. Included studies are summarized in the Table. Results: Six studies met the inclusion criteria. Publication dates ranged from 2001 to 2018. Five studies investigated clinical symptoms and/or electromyography: three of five studies found worsening or persistent median neuropathy, and two of five studies found improvement or no further development of symptoms in their respective patient cohorts. The sixth study found no difference in patient-reported outcomes between either approach. Conclusions: There were no differences in wrist range of motion, postoperative grip strength, or patient-reported outcomes within each of the study cohorts. Based on the findings from the studies included in this review, we do not believe that there is sufficient evidence supporting prophylactic CTR in the setting of surgical treatment of distal radius fractures. Type of study/level of evidence: Therapeutic 2a.