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Review Question - QID 3224

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QID 3224 (Type "3224" in App Search)
A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. She complains of wrist pain and deformity. On physical exam she has no sensation of the volar thumb, index, and middle fingers. Radiographs are provided in Figure A. Two hours following closed reduction, the deformity is corrected, but the numbness and wrist pain is worsening. Which of the following interventions should be taken?
  • A

Evaluation of volar compartment pressures with a needle monitor

2%

79/3180

Icing and elevation of the arm with follow-up evaluation in 8 hours

2%

71/3180

Immediate EMG evaluation of the left upper extremity

0%

15/3180

Closed reduction, carpal tunnel release, and sugar tong splinting

3%

99/3180

Emergent open reduction internal fixation with carpal tunnel release

91%

2890/3180

  • A

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The radiograph demonstrates a displaced distal radius fracture along with a scaphoid fracture, and the patient is presenting with neurologic deficits of acute carpal tunnel syndrome. This is a surgical emergency requiring release of the carpal tunnel to prevent permanent dysfunction.

Dyer et al performed a retrospective cohort comparison of patients with distal radius fractures. Fracture translation was the most significant risk factor for development of acute carpal tunnel syndrome. Ipsilateral extremity fracture and multi-extremity trauma were trending, but not statistically significant risk factors.

In a review article, Schnetzler describes the pathogenesis, evaluation, and treatment of acute carpal tunnel syndrome.

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