title: Median neuropathy in malunited fractures of the distal radius.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinic for Hand Surgery, Rhön-Klinikum, Bad Neustadt, Germany. drkmegerle@gmail.com
authors.forename: Kai
authors.initials: K
authors.lastname: Megerle
authors.forename: Alfred
authors.initials: A
authors.lastname: Baumgarten
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmitt
authors.forename: Jörg
authors.initials: J
authors.lastname: van Schoonhoven
authors.forename: Karl-Josef
authors.initials: KJ
authors.lastname: Prommersberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017759:Fractures, Malunited / Q000150:complications*; D006801:Humans; D008297:Male; D020423:Median Neuropathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy; D015995:Prevalence; D011446:Prospective Studies; D011884:Radius / Q000293:injuries*; D014954:Wrist Injuries / Q000150:complications*; D055815:Young Adult