Background

Distal radius fractures (DRFs) are the most common upper extremity fractures, and

carpal tunnel syndrome (CTS) is one of their recognized complications, sometimes

necessitating surgical decompression.1–5 While acute CTS is generally considered a

surgical urgency, there is no consensus on whether carpal tunnel release (CTR)

should be performed within 24 hours or can be safely delayed up to one week. This

study aimed to compare outcomes of CTR performed emergently (≤24 h) versus

urgently (within 7 days) after DRF.

Methods

This retrospective review of the TriNetX database, adhering to STROBE reporting

guidelines, identified patients with acute DRF who underwent surgical fixation and CTR

within the specified time window. Patients were stratified into two cohorts based on

whether fixation and CTR were performed within 24 hours or within 7 days. Using

diagnosis and procedure codes, CTS-related outcomes and complications were

assessed in propensity score–matched cohorts. Outcomes at 180 days postoperatively

were analyzed using risk ratios and z-tests.

Results

After 1:1 propensity score matching, 5,831 patients who underwent CTR and were

diagnosed with DRF within 24 hours were compared to an equal number of patients

who underwent CTR within 7 days. At 180 days postoperatively, both emergent and

urgent groups had similar rates of CTS diagnosis, median nerve release procedures,

and physical therapy evaluations (p>0.05). Additionally, infection rates, median nerve

neuropathy, and complex regional pain syndrome were similar between the groups

(p>0.05).

Conclusions

Among patients undergoing CTR within 7 days after distal radius fracture, outcomes

were similar to those treated within 24 hours, suggesting that carefully selected

patients may not require emergent decompression. Importantly, there was no

significant difference in the rate of median nerve neuropath regardless of surgical

timing.