DESCRIPTIVE STUDY OF PRESENTATION AND MANAGEMENT OF PATIENT WITH DISTAL RADIUS FRACTURES WITH CHRONIC REGIONAL PAIN SYNDROME TYPE 1

Abstract

Distal Radius Fractures occur frequently and the incidence is on an increasing trend due to old age, as these fractures are commonly seen in elderly in osteoporosis¹. These fractures occur in all age groups. The fracture is usually because of trivial fall in elderly while in younger it is due to high velocity injury. These fractures can be intra or extraarticular. The fractures are treated either by conservative management by closed reduction and below elbow plaster slab/cast. The operative management can include various types of fixation like k-wire fixation, External fixation and ORIF with plating based upon the fracture patterns. These fractures are associated with various complications like malunion, non-union and complex regional pain syndrome type 1(CRPS 1). CRPS 1 occurs with distal radius fractures more frequently than other fractures³. This can occur with fractures treated with both conservative and surgical cases. CRPS 1 is characterized by regional pain that is disproportionate to the severity of injury, with or without abnormal sensory, motor, vasomotor and trophic changes¹. Allodynia or causalgia meaning that there is abnormal response to tactile stimulus in which simple light touch or pressure, shaking hand and even brushing also causes severe pain. Secondarily not just the joint but also the entire upper limb including elbow and shoulder present with severe pain and stiffness thus giving it name of shoulder hand syndrome. The other names for CRPS 1 are Reflex sympathetic dystrophy, causalgia tell about its underlying pathology and manifestations². Though this occurs in both upper and lower limb, it is found that it most common in distal radius fracture as per the available data in literature search. India is unique in that orthopaedic practices and fracture management are not limited to hospitals and doctors³. Many patients even then they are educated tend to go to native/traditional bone setters. The doctors and hospital management of distal radius fractures are changed enormously with respect to rehabilitation protocol. The early mobilization of fingers, thumb, elbow and shoulder in immediate post immobilization cast and post surgery day 1 or 2 have dramatically reduced the number of patients with CRPS 1⁴. However patients treated with native/traditional bone setters are usually immobilize for longer duration of time like 6 to 12 weeks and present to doctors/hospitals for management. Many patients from this set of group come to doctors/hospitals manifested with CRPS 1 of varying degrees. CRPS 1 is associated with severe morbidity and disability. Patient is in full distress due to pain. Prevention is better than cure so early mobilization of adjacent joints in immediate post immobilization/post surgery phase and mobilization of the wrist immediately after post removal of cast/post surgery  is in a way that prevent the occurrence of CRPS 1⁴. The treatment modalities of CRPS 1 available are Medical management such as NSAIDs, centrally acting Analgesics, bisphosphonates, Tricyclic antidepressants, Selective Serotonin reuptake inhibitors and topical applications.Sree Balaji Medical College and Hospital, being a tertiary care institute, We had lots of distal radius cases treated primarily by us and also cases presented late either due to neglect or treated elsewhere in other hospitals or treated with native/traditional bone setters.⁵