Complex Regional Pain Syndrome after Distal Radius Fracture-Case Report and Mini Literature Review

Abstract

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.

Keywords: complex regional pain syndrome (CRPS); distal radius fracture (DRF); mirror therapy.

Figure 1

X-ray after surgery. Distal radius fracture of the left upper limb with K-wire. AP view (A), lateral -view (B).

Figure 2

Comparative radiographic assessment of two wrists in antero-posterior plain shows no bone pathology at the right site. Bone tissue rarefaction is clearly visible on the left side and appears to be like spots. It involves the left carpal bones, the left radial bone, and the proximal part of the I-V left metacarpal bones. There is a loss of joint space between carpal bones and between a distal row of carpal and metacarpal bones.

Figure 3

Graphical presentation of the patient’s treatment course.

Figure 4

Patient’s hand one week after admission to the rehabilitation department. After one week of treatment: slight edema, decreased pain level, and fading redness. Suture after K-wire removal.

Figure 5

Patient’s hands after one month of treatment: improvement in function, further decrease of edema, no redness, no pain.