Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius.
OBJECTIVE
To examine the incidence and predictors of complex regional pain syndrome type I (CRPS I) after fracture of the distal radius.


METHODS
Prospective study.


METHODS
University hospital.


METHODS
A consecutive sample of patients (N=90) with fracture of the distal radius treated by closed reduction and casting.


METHODS
Not applicable.


METHODS
Occurrence of CRPS I, occurrence of pain, wrist and hand range of motion, radiographic measures, Patient-Rated Wrist Evaluation, Hospital Anxiety and Depression Scale, and Medical Outcomes Study 36-Item Short-Form Health Survey at baseline and 1, 3, 6, and 9 months follow-up.


RESULTS
CRPS I occurred in 29 patients (32.2%) with a mean delay ± SD of 21.7±23.7 days from cast removal. Univariate analyses found significant differences between patients with CRPS I and patients without CRPS I at baseline for sex (P=.021), socioeconomic level (P=.023), type of trauma (P=.05), pain at rest and activity (P=.006 and P<.001, respectively), wrist dorsiflexion and pronation (P=.002 and P=.001, respectively), finger flexion (P=.047), thumb opposition (P=.002), function of the hand (P<.001), and physical quality of life (QOL) (P=.013). Logistic regression showed that risk for CRPS I was higher in cases of women (odds ratio [OR]=5.774; 95% confidence interval [CI], 1.391-23.966), medium and low energy trauma patients (OR=7.718; 95% CI, 1.136-52.44), patients with a Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning score <40 (OR=4.931; 95% CI, 1.428-17.025), and patients with Patient-Rated Wrist Evaluation pain subscale score >16 (OR=12.192; 95% CI, 4.484-43.478).


CONCLUSIONS
CRPS I occurs frequently during the third and fourth week after cast removal, especially in women who report severe pain and impairment of physical QOL. Additional prospective studies are required to verify these findings in comminuted and operated fractures of the distal radius.
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia. Electronic address: anisjellad@gmail.com.
Anis
A
Jellad
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
Sana
S
Salah
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
Zohra
Z
Ben Salah Frih
D000328:Adult; D000368:Aged; D005260:Female; D006304:Health Status; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D011788:Quality of Life; D011859:Radiography; D011885:Radius Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D016059:Range of Motion, Articular; D012019:Reflex Sympathetic Dystrophy / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology
Reflex sympathetic dystrophy; Rehabilitation; Risk factors