Median Nerve Compression Secondary to Fractures of the Distal Radius

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Fractures of the distal radius and carpal tunnel syndrome are both commonly occurring entities seen in the wrist. The latter condition is an occasional complication that should be well recognized as a result of the former traumatic condition. While treatment of distal radius fractures is currently undergoing a treatment revolution, the complication of carpal tunnel syndrome should be similarly recognized and given the respect that it deserves. Once significant median nerve injury or compression occurs as a result of a fracture of the distal radius, it can be much more difficult to treat, and the final outcome may be much less predictable than its idiopathic counterpart.

Abraham Colles first described the fracture of the distal radius in 1814 butmaintained that functional deficiency or complications were surprisingly rare after this common traumatic injury [6]. Similarly, carpal tunnel syndrome associated with this fracture was given little attention and initially felt to be a rare sequela. Early textbooks discussing complications of Colles fractures rarely mentioned this nerve compression, and it was not until the classic paper by Abbott and Saunders in 1933 that this complication was clearly recognized as being not as rare as initially thought [1]. The first case report was actually a direct traumatic injury to themedian nerve as recognized by Gensoul in 1836 where he had performed an autopsy on a young girl who died of tetanus following an open fracture of the distal forearm [12]. It was found that the median nervewas caught inthe fracture site of the radius.Many of these early reports focused on the direct compression or contusion of the median nerve as a result of bony impalement or stretching of the nerve, rather than the more commonly seen secondary compression as a result of edema and swelling from this fracture