Acute Carpal Tunnel Syndrome in the Setting of a Distal Radius Fracture in a 75 y/o Female: A Case Report

Background Traumatic acute carpal tunnel syndrome (ACTS) occurs in 4.5-9% of distal radius fractures, predominantly in women. Rapid diagnosis of ACTS with expedient operative release and fixation is critical to prevent permanent debilitating median nerve complications. It is important to perform serial examinations and provide adequate patient education while in the emergency department. Case A 75 y/o right hand dominant female who is dependent on a walker for ambulation with past medical history of hypertension, Parkinson's disease, and deep vein thrombosis presented to the emergency department with left wrist pain after falling onto an outstretched left hand. On examination, she had bruising about the dorsal wrist. Initial two-point discrimination was less than 6mm in both the ulnar and radial distributions yet greater than 10mm in the median. Her digits were warm and well perfused. Radiographs demonstrated a dorsally displaced distal radius fracture with shortening and volar shear. Closed reduction under conscious sedation was performed yielding improved alignment on post-reduction films. Serial examinations revealed worsening median nerve function. She underwent emergent surgical carpal tunnel release and fixation with immediate postoperative improvement. Discussion While most distal radius fractures in patients greater than 65 can be managed nonoperatively, it is crucial to assess the fracture and goals of each patient individually, especially with radiographic findings concerning for median nerve compression. Delaying surgery, high energy trauma, injury severity, and fracture type have been associated with poor patient outcomes. The treatment of ACTS requires expedient surgical intervention. While there are similar functional scores and patient reported outcomes between hardware used, dorsal bridge plating has been shown to allow earlier weight bearing for walker dependent patients. This case report was written to highlight the importance of early recognition of ACTS in distal radius fractures, especially in the elderly who are often discharged quickly after closed reduction and splint application.