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. 2024 Nov 21;19(11):e0314307.
doi: 10.1371/journal.pone.0314307. eCollection 2024.

Complex regional pain syndrome after distal radius fracture: A survey of current practices

Alice Wei Ting Wang  1 , Kelly A Lefaivre  1   2 , Jeffrey Potter  1   2 , Aresh Sepehri  1   2 , Pierre Guy  1   2 , Henry Broekhuyse  1   2 , Darren M Roffey  1   2 , David J Stockton  1   2
Affiliations

Complex regional pain syndrome after distal radius fracture: A survey of current practices

Alice Wei Ting Wang et al. PLoS One. .

Abstract

Introduction: Complex regional pain syndrome (CRPS) is a common complication following distal radius fractures that is difficult to diagnose and can lead to permanent disability. While various proposed prophylaxis and treatment modalities exist, high-quality evidence guiding practice is limited. This survey of Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA) members was conducted with the primary aim of assessing practice patterns in distal radius fractures complicated with CRPS.

Methods: An electronic survey was distributed to practicing orthopaedic surgeons in the COA and OTA. Questions assessed practice setting, preference in management of distal radius fractures and CRPS, comfort level in managing CRPS, and identification of gaps in management. Responses were anonymized and collected over 8 months. Response data was analyzed using descriptive statistics; thematic analysis was used on free text response.

Results: 134 survey responses were completed. 84% of respondents felt the incidence of CRPS in distal radius fractures was 1-10%, while 15% felt it was closer to 11-20%. 24% of respondents utilized the "Budapest Criteria" to diagnose CRPS. 40% offered prophylaxis in patients felt to be at high risk of developing CRPS. 66% of surgeons felt neutral, uncomfortable, or very uncomfortable managing CRPS in distal radius fractures. When asked to consider adopting a prophylactic therapy, 38% of surgeons indicated that a therapy that reduced the absolute risk of CRPS by 6-10% would change their practice. Gaps in current practice included lack of evidence-based treatment and prevention strategies and diagnostic uncertainty.

Conclusion: This study identified that amongst orthopaedic surgeons in the COA and OTA, diagnosis, treatment, and prophylaxis strategies for CRPS in distal radius fractures are heterogeneous. Surgeons are not confident in their treatment of CRPS. Future studies using rigorous research methods are warranted to improve management.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Time when partial weightbearing is allowed (e.g., perform activities of daily living) in A) non-operatively treated and B) operatively treated distal radius fractures.
Fig 2
Fig 2. Features used to diagnose CRPS in distal radius fractures.
Fig 3
Fig 3. Analgesic medications prescribed in patients diagnosed with CRPS in distal radius fracture.
Fig 4
Fig 4. Additional treatment modalities offered to or referred for patients diagnosed with CRPS in distal radius fracture.
Fig 5
Fig 5. Other medical services typically involved for patients diagnosed with CRPS in distal radius fracture.
Fig 6
Fig 6. Absolute risk reduction of potential prophylactic agent for CRPS in distal radius fracture that would change surgeons’ practice.
Fig 7
Fig 7. Common themes identified as clinical and research gaps in treating pain syndromes after distal radius fractures.
See this image and copyright information in PMC

References

    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37: 691–697. doi: 10.1016/j.injury.2006.04.130 - DOI - PubMed
    1. Atkins R. M, Duckworth T. Features of algodystrophy after Colles’ fracture. J Bone Joint Surg Br. 1990;72: 105–10. doi: 10.1302/0301-620X.72B1.2298766 - DOI - PubMed
    1. Moseley GL, Herbert RD, Parsons T, Lucas S, Van Hilten JJ, Marinus J. Intense Pain Soon After Wrist Fracture Strongly Predicts Who Will Develop Complex Regional Pain Syndrome: Prospective Cohort Study. The Journal of Pain. 2014;15: 16–23. doi: 10.1016/j.jpain.2013.08.009 - DOI - PubMed
    1. Jo Y-H, Kim K, Lee B-G, Kim J-H, Lee C-H, Lee K-H. Incidence of and Risk Factors for Complex Regional Pain Syndrome Type 1 after Surgery for Distal Radius Fractures: A Population-based Study. Sci Rep. 2019;9: 4871. doi: 10.1038/s41598-019-41152-x - DOI - PMC - PubMed
    1. Jellad A, Salah S, Ben Salah Frih Z. Complex Regional Pain Syndrome Type I: Incidence and Risk Factors in Patients with Fracture of the Distal Radius. Archives of Physical Medicine and Rehabilitation. 2014;95: 487–492. doi: 10.1016/j.apmr.2013.09.012 - DOI - PubMed

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