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Global Translational Medicine Open carpal tunnel release surgical outcomes

the CTS severity assessment . Nerve conduction studies of open CTR. The classification for the effectiveness
[16]
(NCS) serve as a useful tool for evaluating CTS, aiding in assessment is as follows: If symptoms of CTS persist after
diagnosis, decision-making for the treatment plan (whether surgery, the condition is categorized as persistent; should
conservative or surgery), and predicting post-surgical symptoms of CTS reappear within 3 months or more
prognostic outcomes. Notably, the previous research has following the surgery, it is classified as recurrent; in cases
linked NCS results to poor outcomes for surgical release, where the outcomes show a transition from a severe to
underscoring the significance of addressing clinical a mild or moderate stage of the disease, the treatment is
[18]
[17]
outcomes for the benefit of both patients and surgeons . considered successful . Face-to-face follow-up visits
The objectives of this study were as follows: (i) To were carried out depending on the patient’s needs and
determine the surgical outcomes and complications the assessment of OCTR outcomes. OCTR procedures
following OCTR surgeries; (ii) to compare the presentation were performed at Zliten Teaching Hospital in accordance
of CTS symptoms at the pre-operative stage with those with the severity of the median nerve neuropathy and the
observed at the post-operative follow-up; and (iii) to evaluate recommended clinical guidelines. All surgical operations,
the factors (body mass index and nerve conduction study patient assessments, history taking, and consultations were
severity) associated with post-operative complications. carried out by specialized orthopedic surgeons affiliated
with Zliten Teaching Hospital.
2. Materials and methods The OCTR technique involved the administration of
2.1. Study setting infiltrated local anesthesia during the surgical procedure.
The open technique involved creating an approximately
This study adopted a case series design and was conducted at 3-cm incision aligned with the radial border of the ring
the Department of Orthopedics and Traumatology in Zliten finger, directly over the transverse carpal ligament in the
Teaching Hospital, Libya, spanning from January 2016 to proximal palm. Dissection proceeded through the palmar
December 2018. Patients who opted to undergo an OCTR fascia until reaching the transverse carpal ligament, which
procedure involving the transverse carpal ligament were was divided while being directly observed. In addition,
recruited during the pre-operative stage and prospectively the antebrachial fascia was released several centimeters
followed up for 2 years to assess the surgical outcomes of proximal to the incision, and distally until yellow fat is
OCTR. The demographic information of the patients and observed. As part of the postoperative procedure, dressings
all required data were obtained through a review of the were removed within 3 – 5 days, and hand range of motion
hospital’s medical records and face-to-face meetings. exercises was promptly initiated. The sutures was removed
The study enrolled adult outpatients diagnosed with CTS after 10 days. Subsequently, the median nerve gliding
through clinical classification and nerve conduction study exercise was started.
(NCS), who were deemed unsuitable for conservative (non- Using Krejcie and Morgan’s table for sample size
surgical) approaches. All patients who met the following calculation, it was determined that a sample size of 260
inclusion criteria were considered: (i) Presented CTS was required for a population of 800 outpatients at the
symptoms (numbness, tingling, and pain); (ii) exhibited Department of Orthopedics and Traumatology. Ultimately,
confirmed CTS signs during physical examination, a total of 256 patients met the eligibility criteria and
including a positive Phalen or Tinel sign; and (iii) had CTS regularly attended follow-up sessions. Consequently, these
confirmed by NCS (prolonged distal motor latencies of 256 patients were included in the data analysis.
the median nerve of >4.5 ms or sensory nerve conduction
velocity of <40 m/s). However, this research excluded 2.2. Statistical analysis
pregnant women, patients diagnosed with musculoskeletal Data were entered and analyzed using the Statistical
disorders, peripheral neuropathy, or recurrent CTS, and Package for the Social Sciences, version 23.0. Continuous
patients who refused voluntary participation and/or had variables were expressed as mean and standard deviation
lost in follow-up with the Department of Orthopedics and (SD) for normally distributed data. However, for non-
Traumatology during the study period.
normally distributed data, median and interquartile ranges
Nerve conduction studies were performed on both hands were used. An independent t-test was performed when
by trained clinical technicians, with patients positioned analyzing normally distributed data to assess differences
supine and in a relaxed state. Electrophysiological testing in BMI between patients with and without post-operative
through NCS, as well as clinical presentations during complications. In addition, non-parametric tests, such
pre-operative and post-operative follow-up periods, were as the Chi-square test, were conducted to evaluate the
used as the outcome parameters to assess the effectiveness association between NCS severity and post-operative

Volume 2 Issue 4 (2023) 3 https://doi.org/10.36922/gtm.1019