Meidan Nerve Conduction Velocity after Distal Radius Fracture Fixation with a Volar Locked Plate
Stephen Y. Liu, MD1; Gabriella DiBernardo, BS1; Kia M. Washington, MD2; Robert J. Goitz, MD3; John R. Fowler, MD3; (1)University of Pittsburgh, Pittsburgh, PA, (2)McGowan Institute for Regenerative Medicine, Pittsburgh, PA, (3)Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Purpose: To determine median nerve conduction velocity delay in patients after distal radius fracture and the impact operative fixation with a volar locking plate has on these findings. We hypothesized that a significant percentage of patients would have nerve conduction evidence of carpal tunnel syndrome after initial injury and that surgical fixation with a volar plate would have a minimal impact on median nerve latencies.
Methods: This is a prospective cohort study of fourteen asymptomatic patients that underwent treatment of a distal radius fracture with a volar locking plate. All patients were operated on within 2-weeks of injury. On the day of surgery and at the 6-week follow-up, patients were evaluated via clinical exam, quickDASH, and a nerve conduction study using a hand-held device – ADVANCED-NCS (NeuroMetrix;Waltham, MA). Nerve conduction velocities of the contralateral limb at the 6-week visit were used as a baseline. Pre-operative and post-operative nerve function was compared to baseline using a 2-tailed student t-test. The latency values were assessed for correlation to the quickDASH using the Pearson coefficient. Significance was set to p < 0.05.
Results: Asymptomatic patients after distal radius fracture have a 28% incidence carpal tunnel syndrome as defined by median distal sensory latency. Distal sensory latencies of the median nerve were 3.64 ± 0.32ms at baseline, 3.761 ± 0.70ms after fracture, and 3.81 ± 0.52ms post-operatively. Distal motor latencies of the median nerve were 3.91 ± 0.59ms, 3.60 ± 0.68, and 3.88 ± .36ms at respective time points. There was no significant difference between baseline, pre-operative, and post-operative median nerve latencies. Patient QDASH scores improved from an average of 77 to 46 points in the 6-weeks they were followed. QDASH scores showed weak correlation, r = 0.091-0.166, to NCV latencies.
Conclusions: There is a subset of asymptomatic patients that will have nerve conduction velocities diagnostic of carpal tunnel syndrome after distal radius fracture. Surgical fixation with a volar locked plate in our series did not prolong median nerve latency across the wrist and no patient required carpal tunnel release post-operatively.
Level of Evidence: Prognostic level II.
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