Article

OBJECTIVE: To examine the incidence and predictors of complex regional pain
syndrome type I (CRPS I) after fracture of the distal radius. DESIGN: Prospective
study. SETTING: University hospital. PARTICIPANTS: A consecutive sample of
patients (N=90) with fracture of the distal radius treated by closed reduction
and casting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
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