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Objective results of median nerve decompression and tenosynovectomy for carpal tunnel syndrome in patients with mucopolysaccharidoses Types I and II

always repaired as much as possible to cover the plate. Post-operatively, patients were followed up in 13 days to allow gentle mobilization. The interval between subsequent follow-ups varied at the surgeon’s discretion; however all 86 patients were seen up to a minimum of 8 months post-operatively, when tendon function was clinically assessed. We observed an overall complication rate of less than 13% (11 of 86 patients), mainly in the form of carpal tunnel syndrome, neurapraxia, infection and joint stiffness. There were no cases of tendon rupture. Our low tendon rupture rate mirrors that of Ward et al. (2011). Their overall complication rate was 22%, mainly in the form of nerve dysfunction, with 6% of patients losing reduction. Although two patients experienced transient flexor pollicis longus dysfunction, there were no tendon ruptures. They suggested that possible explanations for the low incidence of tendon complications were increasing familiarity with the hardware, careful avoidance of screw penetration of the dorsal cortex and careful placement of the plate proximal to the watershed line. In the technique used in the present series, the distal screw length is routinely downsized by 2 mm from the depth at which the drill bit is noted to just penetrate the dorsal cortex when drilling, the intention being to prevent the screw tips from encroaching on the extensor compartment. A recent study advised surgeons not to trust the image intensifier when judging distal subchondral screw length (Park and Goldie, 2012). Using computed tomography and magnetic resonance image scans of the wrist, the study identified a consistent valley with a depth averaging 1.8 mm in the intermediate column between Lister’s tubercle and the sigmoid notch of the distal radius, making it difficult to rely on fluoroscopy to judge screw length. In view of this, the intra-operative technique described in this letter was advised; we have found it to have beneficial outcomes on the rate of tendon rupture.