Top

Archives of Orthopaedic and Trauma Surgery

Published in:

20-05-2023 | Distal Radius Fracture | Trauma Surgery

Incidence and risk factors for complex regional pain syndrome in radius fractures: meta-analysis

Authors: Alejandro Lorente, Gonzalo Mariscal, Rafael Lorente

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2023

Abstract

Purpose

This meta-analysis aimed to evaluate the incidence and risk factors for complex regional pain syndrome (CRPS) in radius fractures.

Methods

The meta-analysis was performed using the PubMed, Embase, Scopus, and Cochrane Collaboration Library databases. Studies focusing on patients with conservative or surgically treated radius fractures leading to CRPS were included. A control group consisting of patients with radius fractures and no CRPS (−) was included. The outcome measures were incidence and risk factors. Comparative studies were also included. Data were combined using Review Manager 5.4.

Results

Out of 610 studies, nine studies were included. The incidence of CRPS after radius fractures ranged from 0.19 to 13.63% (95% CI: 11.12–16.15%). Open fractures, high-energy mechanisms in radial head fractures, and associations with ulnar fractures were risk factors for CRPS [(RR: 0.98; 95% CI: 0.97–1.00), (RR: 0.18; 95% CI: 0.07–0.47), and (RR: 1.25; 95% CI: 1.17–1.35), respectively]. Other risk factors were female sex and high body mass index [(RR: 1.20; 95% CI: 1.05–1.37) and (MD: 1.17; 95% CI: 0.45–1.88)]. Psychiatric factors also increased the incidence of CRPS (RR: 2.04; 95% CI: 1.83–2.28). On the other hand, the type of surgery (external fixation or open reduction and internal fixation) and manipulations; associated comorbidities (diabetes and hypertension) together with tobacco and alcohol abuse; marital status, educational level, employment status, and socioeconomic status were not risk factors (p > 0.05).

Conclusion

The incidence of CRPS in radius fractures was 13.63%. Fractures with greater complexity or greater associated tissue damage, female sex, high BMI, and psychiatric disorders were risk factors for the development of CRPS.

Level of evidence

Meta-analysis of cohort and case series studies; II.

Available only for authorised users

Aïm F, Klouche S, Frison A, Bauer T, Hardy P (2017) Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: a systematic review and meta-analysis. Orthop Traumatol Surg Res 103(3):465–470PubMedCrossRef

Beerthuizen A, Spijker A, Huygen FJPM, Klein J, Wit R (2009) Is there an association between psychological factors and the complex regional pain syndrome type 1(CRPS1) in adults? a systematic review. Pain 145:52–59PubMedCrossRef

Buryanov A, Kostrub A, Kotiuk V (2017) Endocrine disorders in women with complex regional pain syndrome type I. Eur J Pain 21(2):302–308PubMedCrossRef

Cappello ZJ, Kasdan ML, Louis DS (2012) Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. J Hand Surg Am 37:288–296PubMedCrossRef

Coderre TJ, Bennett GJ (2010) A hypothesis for the cause of complex regional pain syndrome-type I (reflex sympathetic dystrophy): pain due to deep-tissue microvascular pathology. Pain Med 11(8):1224–1238PubMedCrossRef

Crijns TJ, van der Gronde BATD, Ring D, Leung N (2018) Complex regional pain syndrome after distal radius fracture is uncommon and is often associated with fibromyalgia. Clin Orthop Relat Res 476(4):744–750PubMedPubMedCentralCrossRef

Dilek B, Yemez B, Kizil R et al (2012) Anxious personality is a risk factor for developing complex regional pain syndrome type I. Rheumatol Int 32(4):915–920PubMedCrossRef

Dutton LK, Rhee PC (2021) Complex regional pain syndrome and distal radius fracture: etiology, diagnosis, and treatment. Hand Clin 37(2):315–322PubMedCrossRef

Elsamadicy AA, Yang S, Sergesketter AR et al (2018) Prevalence and cost analysis of complex regional pain syndrome (CRPS): a role for neuromodulation. Neuromodulation 21(5):423–430PubMedCrossRef

10.

Farzad M, Layeghi F, Hosseini A et al (2018) 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. J Hand Surg Asian Pac 23(4):554–561CrossRef

11.

Field J, Gardner F (1997) Psychological distress associated with algodystrophy. J Hand Surg Br 22:100–101PubMedCrossRef

12.

FinnmannMunk AS, Petersen KK, Bødtker S, Walther-Larsen S et al (2022) Long-term biopsychosocial issues and health-related quality of life in young adolescents and adults treated for childhood complex regional pain Syndrome, type 1. Scand J Pain 22(3):473–482CrossRef

13.

Ghai B, Dureja GP (2004) Complex regional pain syndrome: a review. J Postgrad Med 50:300–307PubMed

14.

Guyatt GH, Thorlund K, Oxman AD et al (2013) GRADE guidelines: 13. preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol 66(2):173–183PubMedCrossRef

15.

Harden RN, Bruehl S, Stanton-Hicks M et al (2007) Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 8:326–331PubMedCrossRef

16.

Neumeister MW, Romanelli MR (2020) Complex regional pain syndrome. Clin Plast Surg 47(2):305–310PubMedCrossRef

17.

Harden RN, Rudin NJ, Bruehl S et al (2004) Increased systemic catecholamines in complex regional pain syndrome and relationship to psychological factors: a pilot study. Anesth Analg 99(5):1478–1485PubMedCrossRef

18.

Jellad A, Salah S, Ben Salah Frih Z (2014) Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil 95(3):487–492PubMedCrossRef

19.

Jia S, Ren C, Shi X et al (2022) Relative prevalence and associated factors of complex regional pain syndrome type I in patients with radial head fractures treated with open reduction and internal fixation: a cross-sectional study. Pain Res Manag 2022:9214404PubMedPubMedCentralCrossRef

20.

Jo YH, Kim KW, Lee BG et al (2019) Incidence of and risk factors for complex regional pain syndrome type 1 after surgery for distal radius fractures: a population-based study. Sci Rep 9(1):1–7CrossRef

21.

Kawai T, Autieri MV, Scalia R (2021) Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol 320(3):C375–C391PubMedCrossRef

22.

Kessler A, Yoo M, Calisoff R (2020) Complex regional pain syndrome: an updated comprehensive review. NeuroRehabilitation 47(3):253–264PubMedCrossRef

23.

Lee BH, Scharff L, Sethna NF, McCarthy CF, Scott-Sutherland J, Shea AM, Sullivan P, Meier P, Zurakowski D, Masek BJ, Berde CB (2002) Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. J Pediatr 141(1):135–140PubMedCrossRef

24.

Lee S-U, Na K-T, Lee Y-M, Park JH, Joo SY (2020) Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures. J Orthop Surg Res 15(1):328PubMedPubMedCentralCrossRef

25.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100PubMedPubMedCentralCrossRef

26.

Littlejohn GO, Guymer E (2019) Chronic pain syndromes: overlapping phenotypes with common mechanisms. Research 8:F1000

27.

Löw S, Papay M, Eingartner C (2019) Pain perception following initial closed reduction in the preoperative care of unstable, dorsally displaced distal radius fractures. J Hand Microsurg 11(2):111–116PubMedPubMedCentralCrossRef

28.

Löw S, Papay M, Spies CK et al (2020) The requirement for closed reduction of dorsally displaced unstable distal radius fractures before operative treatment. Dtsch Arztebl Int 117(46):783–789PubMedPubMedCentral

29.

Lu Y, Beletsky A, Chahla J et al (2021) How can we define clinically important improvement in pain scores after biceps tenodesis? J Shoulder Elbow Surg 30(2):430–438PubMedCrossRef

30.

Martini ML, Caridi JM, Zeldin L et al (2020) Perioperative outcomes of spinal cord stimulator placement in patients with complex regional pain syndrome compared with patients without complex regional pain syndrome. World Neurosurg 137:e106–e117PubMedCrossRef

31.

Merskey H, Bogduk N (1994) Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. IASP Press, Seattle

32.

Ochoa JL, Verdugo RJ (2010) Neuropathic pain syndrome displayed by malingerers. J Neuropsychiatry Clin Neurosci 22(3):278–286PubMedPubMedCentralCrossRef

33.

Ortiz-Romero J, Bermudez-Soto I, Torres-González R, Espinoza-Choque F, Zazueta-Hernandez JA, Perez-Atanasio JM (2017) Factors associated with complex regional pain syndrome in surgically treated distal radius fracture. Acta Ortop Bras 25(5):194–196PubMedPubMedCentralCrossRef

34.

Roh YH, Lee BK, Noh JH et al (2014) Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 134(12):1775–1781PubMedCrossRef

35.

Sergent F, Mouroko D, Sellam R, Marpeau L (2003) Algoneurodystrophie de la cheville au cours d’une grossesse: particularités et prise en charge thérapeutique [Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management]. Gynecol Obstet Fertil 31(6):543–545PubMedCrossRef

36.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716PubMedCrossRef

37.

Stanton-Hicks M, Jänig W, Hassenbusch S, Haddox JD, Boas R, Wilson P (1995) Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 63(1):127–133PubMedCrossRef

38.

Teodorczyk-Injeyan JA, Triano JJ, Injeyan HS (2019) Nonspecific low back pain: inflammatory profiles of patients with acute and chronic pain. Clin J Pain 35(10):818–825PubMedPubMedCentralCrossRef

39.

Veldman PH, Reynen HM, Arntz IE, Goris RJ (1993) Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 342:1012–1016PubMedCrossRef

40.

Wang Y, Jiang M, Dai X, Zhang Q (2022) Determinants of complex regional pain syndrome type I among radial head fracture patients with unilateral arthroplasty. Orthop Surg 14(7):1395–1403PubMedPubMedCentralCrossRef

41.

Xu J, Tang Y, Xie M et al (2016) Activation of cannabinoid receptor 2 attenuates mechanical allodynia and neuroinflammatory responses in a chronic post-ischemic pain model of complex regional pain syndrome type I in rats. Eur J Neurosci 44(12):3046–3055PubMedCrossRef

42.

Zollinger PE, Kreis RW, van der Meulen HG, van der Elst M, Breederveld RS, Tuinebreijer WE (2010) No higher risk of CRPS after external fixation of distal radial fractures—subgroup ana- lysis under randomised vitamin C prophylaxis. Open Orthop J 4:71–75PubMedPubMedCentral

Title: Incidence and risk factors for complex regional pain syndrome in radius fractures: meta-analysis
Authors: Alejandro Lorente
Gonzalo Mariscal
Rafael Lorente
Publication date: 20-05-2023
Publisher: Springer Berlin Heidelberg
Keywords: Distal Radius Fracture
Radial Head Fracture
Radius Fracture
Complex Regional Pain Syndrome
Radial Head Fracture
Complex Regional Pain Syndrome
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04909-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and risk factors for complex regional pain syndrome in radius fractures: meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 9/2023

Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases

Survivorship of the dual-mobility construct in elective primary total hip replacement: a systematic review and meta-analysis including registry data

Radiostereometric analysis: comparison of radiation dose and precision in digital and computed radiography

Continuous real-time biofeedback in orthosis improves partial weight bearing on stairs

Extension osteotomy of the metacarpal I and ligamentoplasty of the trapeziometacarpal joint for the treatment of early-stage osteoarthritis and instability of the trapeziometacarpal joint

Correction to: Extension osteotomy of the metacarpal I and ligamentoplasty of the trapeziometacarpal joint for the treatment of early‑stage osteoarthritis and instability of the trapeziometacarpal joint