my personal edition > orthopaedics other > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Few Complications In Endoscopic, Open Tunnel Carpal Releases: Presented at AAOS

By Jill Stein
Special to DG News

NEW ORLEANS, LA -- February 6, 2003 -- Complication rates between endoscopic and open tunnel carpal release are low and not statistically different, researchers report.

Endoscopic procedures recorded more tendon lacerations as complications while the open release resulted in more wound problems, show results of a study presented at the Annual Meeting of the American Association of Orthopedic Surgeons (AAOS).

Dr. Leon Benson, with Evanston Hospital in Illinois, United States, and associates compared the two procedures using studies drawn from a Medline search for the years 1960 through 2002. In order to be selected for inclusion in the analysis, papers had to have delineated complications of surgery in patients who had undergone carpal tunnel surgery by any means. Only patients who had undergone carpal tunnel surgery as a single operative procedure to manage carpal tunnel syndrome were eligible. Carpal tunnel approaches included standard open incision, limited open incision, two portal endoscopic, and single portal endoscopic.

Overall, the study included 43 papers describing patients who had undergone endoscopic carpal tunnel release and 27 papers involving open carpal tunnel release. These papers accounted for 10,319 endoscopic procedures and 4,549 open procedures. The authors' own series added another 1,810 endoscopic procedures and 2,044 open cases.

For endoscopic release, the overall structural complication rate (damage to nerves, arteries, or tendons) was 1.87%. The incidence of median or ulnar nerve laceration was 0.28%, and the incidence of digital nerve laceration was 0.04%, yielding a total rate of permanent nerve injury of 0.32%. The incidence of transient neuropraxia to any nerve was 1.50%. The risk of superficial arch damage was 0.02%, and the incidence of tendon laceration was 0.04%.

For open carpal tunnel surgery, the overall structural complication rate was 0.88%. Digital nerve injury occurred in 0.34% of patients, transient neuropraxia in 0.35%, and median or ulnar nerve laceration in 0.13%. The rate of permanent injury to any nerve for the open procedure s was 0.47%.

If transient neuropraxias are excluded from the analysis, the endoscopic and open complication rates vary by only 0.15%, with the open technique having a slightly higher complication rate.

While major complication rates for carpal tunnel surgery are low, there are no operations that are risk-free, Dr. Benson cautioned. He urged that patients and physicians work together to develop a treatment plan best suited that takes into account both the patient's and surgeon's specific preferences. Also, while major complications are infrequent, it is important that surgeons discuss with patients the potential for nerve, artery, or tendon damage.

E-Mail this DGDispatch to a colleague

To print, use this version