Carpal tunnel release during distal radius fracture fixation is not associated with reduced subsequent carpal tunnel release: A propensity-matched cohort study.

Abstract

Concomitant carpal tunnel release (CTR) during distal radius fracture (DRF) fixation is performed with the goal of preventing symptomatic carpal tunnel syndrome (CTS). However, evidence supporting this practice remains limited. This study evaluated whether CTR at the time of DRF open reduction and internal fixation reduces subsequent CTR procedures and other associated surgical complications. A retrospective cohort study using the TriNetX database identified adult patients who underwent DRF open reduction and internal fixation between 2010 and 2025. Patients were categorized based on whether they received CTR at the time of DRF fixation. Propensity score matching controlled for demographic and clinical variables, including fracture complexity. The primary outcome was subsequent CTR procedure within 2 years. Secondary outcomes included 90-day complications (emergency department visits, readmission, hematoma) and 1-year surgical complications (infection, malunion/nonunion surgery, revision surgery). Among 53,565 patients identified, 5090 matched pairs were analyzed. Patients who received CTR at the time of DRF fixation did not have significantly different rates of subsequent CTR at 1 year (1.75% vs 1.61%; HR 1.112, 95% CI 0.824-1.501) or 2 years (2.24% vs 1.79%; HR 1.306, 95% CI 0.992-1.721). CTR at the time of DRF fixation was associated with higher rates of revision DRF surgery at both 1 year (2.97% vs 2.10%) and 2 years (3.32% vs 2.36%), malunion/nonunion surgery at both 1 year (0.92% vs 0.53%) and 2 years (0.98% vs 0.63%), and 90-day emergency department visits (7.62% vs 6.03%). Infection rates were not significantly different at 1 year or 2 years. CTR at the time of DRF fixation was not associated with reduced subsequent CTR procedures. These findings do not support routine CTR during DRF fixation.