Is Carpal Tunnel Release Necessary in High-Energy Distal Fractures of the Radius?

Purpose This study aimed to compare the clinical outcomes of patients who underwent volar plate osteosynthesis for high-energy distal radius fracture (DRFx) and carpal tunnel release (CTR) for acute or subacute carpal tunnel syndrome (CTS) with patients who did not undergo CTR. Methods This study is a retrospective evaluation of all high-energy DRFx treated with volar plate osteosynthesis in a regional hospital between January 2021 and January 2023. All adult patients (≥18 years) who underwent open reduction and internal fixation were included in the study after obtaining approval from the internal review board of our institution. Only patients who underwent plate osteosynthesis of the volar aspect through a modified Henry incision and patients who underwent CTR through a classic separate incision were included in the study. Clinical results include hand dynamometry, visual analog scale (VAS) scores, and physical examination findings of patients who underwent volar plate osteosynthesis because of high-energy DRFx and CTR due to CTS in the acute and subacute periods were retrospectively examined. Results Among the patients who underwent volar plate osteosynthesis because of high-energy DRFx, no statistically significant difference was detected between the hand grip strength and VAS scores of patients who underwent CTR because of acute CTS and subacute CTS at the sixth postoperative week (p>0.05). Conclusion Prophylactic CTR may be performed in the same session in selected cases, such as DRFx caused by a high-energy injury, to establish a scale for DRFx at a high risk of CTS and avoid delays in treatment. CTR for transient CTS detected in the subacute period during outpatient follow-up does not improve clinical outcomes.

Does Immobilization of Distal Radius Torus Fractures Affect Treatment Outcome?

OBJECTIVE: The aim of this study is to compare the clinical results of splint, short arm circular plaster, and soft bandage immobilization methods applied in the treatment of wrist torus fractures in a single center. METHODS: Patients treated for torus fractures at a tertiary trauma hospital between January 2018 and January 2022 were analyzed retrospectively. According to the physician's preference, a splint, short arm circular plaster, or soft bandage was applied to each patient. The treatment modalities, the number of hospital admissions during the treatment, the number of radiological imaging procedures used during the treatment, immobilization time, and the follow-up periods of the patients were checked and noted on the hospital data processing system. RESULTS: Six hundred ten patients were included in the study. It was determined that 351 patients were treated with a short arm splint, 155 with a short arm circular cast, and 104 with soft bandaging. The number of radiological imaging procedures, the number of hospital admissions during the treatment, the duration of the pain complaint, and the complication rate of the patients treated with splint were significantly lower than the groups treated with short arm circular plaster and soft bandage (P < 0.001). CONCLUSIONS: It was observed that patients who were immobilized with a short arm splint required less follow-up time and fewer imaging procedures and hospital admissions and experienced earlier pain relief and lower complication rates. We think that the use of short arm splints in the treatment of torus fractures is sufficient, safe, and advantageous.

Carpal tunnel decompression: a comparison of elderly and younger patients' sleep quality.

The current study was conducted to evaluate sleep disturbances by age group in patients who underwent carpal tunnel decompression (CTD). Individuals who applied to the orthopedic outpatient clinic and had CTD between 2018 and 2022 had their medical records reviewed. Pre-operative data included patient demographics and the Pittsburgh Sleep Quality Index (PSQI). All post-surgery patients who returned for suture removal were clinically evaluated. Patients were requested to return for re-scoring on the PSQI 6 months after CTD. The cases' average age was 56.44±9.37 years. The study divided its subjects into two age ranges: those between the ages of 45 and 60 (82.2%) (Group1) and those between the ages of 70 and 85 (17.8%) (Group 2). The PSQI values of Group 1 were found to be significantly lower than Group 2. Preoperative PSQI levels were compared to post-op values at 2 weeks and 6 months, and both measurements decreased significantly. Sleep quality improved in all patient groups, regardless of their age, following CTD. Elderly patients had delayed improvements in sleep quality following CTD. The PSQI was effective in determining improvement following CTD, particularly in younger patients, and the progress remained for 6 months.