Can we reduce the incidence of complex regional pain syndrome type I in distal radius fractures? The Liverpool experience

Hand Therapy ◽  
2016 ◽  
Vol 21 (4) ◽  
pp. 123-130 ◽  
Author(s):  
Sharon Gillespie ◽  
Fiona Cowell ◽  
Graham Cheung ◽  
Daniel Brown
Keyword(s):  
Distal Radius Fracture ◽  
Complex Regional Pain Syndrome ◽  
Distal Radius ◽  
Pain Syndrome ◽  
Warning Signs ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Type I ◽  
Syndrome Type ◽  
Radius Fractures

Introduction Complex regional pain syndrome is a multifaceted condition, which is relatively common after distal radius fracture. Method A series of audits and service evaluations were conducted from 2004 to 2013 to investigate the incidence of complex regional pain syndrome type I and any correlation to tight, restrictive, over-flexed casts. Simple subsequent clinical and patient management changes were implemented and impact re-evaluated. Results These audits have contributed to organisational learning and a subsequent reduction in the incidence of complex regional pain syndrome type I in non-operatively managed distal radius fracture from 25%, in keeping with expected incidence in the relevant literature, to a rare event (<1%). Conclusion The authors suggest that careful attention to the prevention of complex regional pain syndrome through staff and patient awareness, vigilance for warning signs and minor modifications to the traditional management of distal radius fractures can significantly reduce the incidence of complex regional pain syndrome type I after distal radius fracture.

439 DISTAL RADIUS FRACTURES AND COMPLEX REGIONAL PAIN SYNDROME TYPE I

2006 ◽  
Vol 10 (S1) ◽  
pp. S117a-S117
Author(s):  
Ç. Bircan ◽  
S. Gülbahar ◽  
Ö. El ◽  
M. Özkan ◽  
Y. Arslan ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Distal Radius ◽  
Pain Syndrome ◽  
Distal Radius Fractures ◽  
Type I ◽  
Syndrome Type ◽  
Radius Fractures

Distal Radius Fracture

2019 ◽  
pp. 39-51
Author(s):  
Sharon Jiang ◽  
Jack M. Berger ◽  
Luke Nicholson
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Pain Syndrome ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Tunnel Syndrome ◽  
Operative Fixation ◽  
Orthopedic Injuries ◽  
Interventional Therapies

This chapter discusses distal radius fractures, which are one of the most commonly encountered orthopedic injuries and cause significant pain in both the nonoperative and operative setting. Regional anesthesia, administered commonly in the form of brachial plexus blocks, provides for reliable analgesia during closed reduction, operative fixation, and the postoperative period. Complications related to distal radius fractures include carpal tunnel syndrome, compartment syndrome, symptomatic malunion, persistent wrist pain, and complex regional pain syndrome (CRPS). Following distal radius fracture management, follow-up is warranted for the development of CRPS, for which a variety of pharmacologic and interventional therapies may be considered.

Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study

2018 ◽  
Vol 23 (04) ◽  
pp. 554-561 ◽  
Author(s):  
Maryam Farzad ◽  
Fereydoun Layeghi ◽  
Ali Hosseini ◽  
Al Dianat ◽  
Nadiyeh Ahrari ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Distal Radius Fracture ◽  
Complex Regional Pain Syndrome ◽  
Distal Radius ◽  
Psychological Factors ◽  
Pain Syndrome ◽  
Base Line ◽  
Type I ◽  
Syndrome Type ◽  
One Year

Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF). Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. The Beck depression inventoryshort form (BDI), State-Trait Anxiety Inventory, and Numerical pain rating scale were used to determine the patients’ psychological features and pain intensity at the base line and 8 weeks after the fracture. Results: CRPS I developed in 15 (25%) patients after eight weeks and just last in 10 (16.67%) patients after one year. No difference was found between the two groups (CRPS and non-CRPS group) in terms of state (STAI-I) and trait (STAI-II) anxiety, and BDI score. Pain at the base line was the most important risk factor in developing CRPS (odds ratio [OR] =1.52; 95% CI). Conclusions: After fracturing the distal radius, patients who have high pain intensity have a higher risk of developing CRPS I. To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions.

scholarly journals Decreasing incidence of complex regional pain syndrome in the Netherlands: a retrospective multicenter study

2021 ◽  
pp. 204946372110419
Author(s):  
Tjitske D Groenveld ◽  
Emily Z Boersma ◽  
Taco J Blokhuis ◽  
Frank W Bloemers ◽  
Jan Paul M Frölke
Keyword(s):  
The Netherlands ◽  
Distal Radius Fracture ◽  
Complex Regional Pain Syndrome ◽  
Distal Radius ◽  
Pain Syndrome ◽  
Annual Incidence ◽  
Radius Fracture ◽  
National Database ◽  
Type I ◽  
Fracture Management

Background: Complex regional pain syndrome type I (CRPS) is a symptom-based diagnosis of which the reported incidence varies widely. In daily practice, there appears to be a decrease in incidence of CRPS after a distal radius fracture and in general. Questions/purposes: The aim of this study was to assess the trend in the incidence of CRPS after a distal radius fracture and in general in the Netherlands from 2014 to 2018. Methods: The incidence of CRPS after a distal radius fracture was calculated by dividing the number of confirmed cases of CRPS after distal radius fracture by the total number of patients diagnosed with a distal radius fracture. Medical records of these patients were reviewed. Hospital-based data were used to establish a trend in incidence of CRPS in general. A Dutch national database was used to measure the trend in the incidence of CRPS in the Netherlands by calculating annual incidence rates: the number of new CRPS cases, collected from the national database, divided by the Dutch mid-year population. Results: The incidence of CRPS after distal radius fracture over the whole study period was 0.36%. Hospital data showed an absolute decrease in CRPS cases from 520 in 2014 to 223 in 2018. National data confirmed this with a decrease in annual incidence from 23.2 (95% CI: 22.5–23.9) per 100,000 person years in 2014 to 16.1 (95% CI: 15.5–16.7) per 100,000 person years in 2018. Conclusion: A decreasing trend of CRPS is shown in this study. We hypothesize this to be the result of the changing approach towards CRPS and fracture management, with more focus on prevention and the psychological aspects of disproportionate posttraumatic pain. Level of Evidence: level 3 (retrospective cohort study).

Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽  
2021 ◽  
pp. 155894472199973
Author(s):  
Nicholas Munaretto ◽  
Adam Tagliero ◽  
Raahil Patel ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Functional Classification ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

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