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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 8, 1069-1076.
doi: 10.1302/0301-620X.89B8.18620  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Delayed recovery and late development of complex regional pain syndrome in patients with an isolated fracture of the distal radius

PREDICTION OF A REGIONAL INFLAMMATORY RESPONSE BY EARLY SIGNS

R. J. A. Goris, MD, PhD, Emeritus Professor of Surgery1; M. Leixnering, MD, Trauma Surgeon2; W. Huber, MD, Trauma Surgeon3; M. Figl, MD, Trauma Surgeon2; M. Jaindl, MD, Trauma Surgeon4; and H. Redl, PhD, Professor5

1 Voshollei 2a bus 4f, 2930 Brasschaat, Belgium.
2 Lorenz Böhler Hospital
3 UKH Linz, Garnisonstrasse 7, A-4017 Linz, Austria.
4 Department of Traumatology University Hospital Währinger Gürtel 18-20, A-1090 Vienna, Austria.
5 Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, A-1200 Vienna, Austria.

Correspondence should be sent to Professor R. J. A. Goris; e-mail: rja.goris{at}skynet.be

We studied prospectively the regional inflammatory response to a unilateral distal radial fracture in 114 patients at eight to nine weeks after injury and again at one year. Our aim was to identify patients at risk for a delayed recovery and particularly those likely to develop complex regional pain syndrome. In order to quantify clinically the inflammatory response, a regional inflammatory score was developed. In addition, blood samples were collected from the antecubital veins of both arms for comparative biochemical and blood-gas analysis.

The severity of the inflammatory response was related to the type of treatment (Kruskal-Wallis test, p = 0.002). A highly significantly-positive correlation was found between the regional inflammatory score and the length of time to full recovery (r2 = 0.92, p = 0.01, linear regession). A regional inflammatory score of 5 points with a sensitivity of 100% but a specificity of only 16% also identified patients at risk of complex regional pain syndrome. None of the biochemical parameters studied correlated with regional inflammatory score or predicted the development of complex regional pain syndrome.

Our study suggests that patients with a distal radial fracture and a regional inflammatory score of 5 points or more at eight to nine weeks after injury should be considered for specific anti-inflammatory treatment.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General