title: Acute Median Neuropathy and Carpal Tunnel Release in Perilunate Injuries Can We Predict Who Gets a Median Neuropathy?
abstract: This study addressed the following null hypotheses: 1) There are no demographic differences between patients with perilunate dislocation (PLD) or fracture-dislocation (PLFD); 2) There are no factors associated with the development of median nerve symptoms in the setting of a PLD or PLFD; and 3) There are no factors associated with carpal tunnel release. Using a retrospective search of a prospective trauma database, we identified all patients who had sustained a radiologically confirmed PLD or PLFD over a 10-year period at two trauma centers. From the medical records we identified median nerve symptoms and carpal tunnel release in addition to demographic and injury characteristics. Among the 71 patients treated for PLD or PLFD, acute median neuropathy was diagnosed in 33 patients (47 %). The only significant difference between PLD and PLFD was a younger age with PLFD. No demographic or injury factors were associated with symptoms of median neuropathy. Carpal tunnel release surgery during the initial operative management was related to the presence of median nerve symptoms and the trauma center. We report a high incidence of acute median neuropathy accompanying perilunate injuries. As there are no demographic or injury factors associated with symptoms of median neuropathy; all patients with PLD/PLFD merit equally high vigilance for acute median neuropathy.
  
  
  METHODS
  Level III, prognostic study.
authors.affiliation: Foundation Doctor and Honorary Clinical Research Fellow of the University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU UK.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Wickramasinghe
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Duckworth
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU UK.
authors.forename: Nick D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA.
authors.forename: Michiel G
authors.initials: MG
authors.lastname: Hageman
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU UK.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: McQueen
authors.affiliation: Harvard Medical School and Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Carpal tunnel release; Epidemiology; Median neuropathy; Perilunate dislocations; Perilunate fracture-dislocations