Complications of endoscopic and open carpal tunnel release.
OBJECTIVE
To compile the major complications of carpal tunnel surgery and compare reported complications for open and endoscopic techniques.


METHODS
A literature assessment was performed for published complications of open and endoscopic carpal tunnel release procedures; 80 publications, representing a period from 1966 through 2001, were reviewed. Complications were identified as neurapraxia; nerve, tendon, or artery injury; and wound infection or dehiscence that required antibiotics or additional operative care. Differences in the proportions of complications between carpal tunnel release procedures were explored with the use of Fisher exact tests.


RESULTS
The literature review yielded 22,327 cases of endoscopic carpal tunnel release and 5,669 cases of open carpal tunnel release. For structural damage to nerves, arteries, or tendons, the incidence for open carpal tunnel release is 0.49% and for endoscopic methods (transbursal and extra-bursal), 0.19%. This difference is statistically significant (P < .005; 2-tailed Fisher exact test) and suggests that the overall proportion of structural complications for open carpal tunnel release according to our complication selection criteria is greater than the overall proportion of complications for endoscopic carpal tunnel release.


CONCLUSIONS
The proportion of complications for carpal tunnel release, performed through an endoscopic or open approach, is very low. Selection of an open versus an endoscopic approach on the basis of structural complications for nerve, arteries, or tendons is not supported by statistical analysis of published complications.


METHODS
Level III, retrospective comparative therapeutic study.
Benson
Leon S
LS
Illinois Bone and Joint Institute, Northwestern University Feinberg School of Medicine, Glenview, Illinois, USA. leon.benson@comcast.net
Bare
Aaron A
AA
Nagle
Daniel J
DJ
Harder
Valerie S
VS
Williams
Craig S
CS
Visotsky
Jeffrey L
JL
D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans