Incidence of and Risk Factors for Complex Regional Pain Syndrome Type 1 after Surgery for Distal Radius Fractures: A Population-based Study

Young-Hoon Jo,Chang-Hun Lee,Kangwook Kim,Joo-Hak Kim,Bong-Gun Lee,Kwang-Hyun Lee

doi:10.1038/s41598-019-41152-x

Young-Hoon Jo, Chang-Hun Lee + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-41152-x

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Abstract

This study aimed to evaluate the incidence rates of and risk factors for complex regional pain syndrome type 1 (CRPS-1) after surgery for distal radius fractures (DRFs). Using data from January 2007 to December 2014, we analysed the data from the Korean Health Insurance Review and Assessment (HIRA) service. After extracting the data of patients aged ≥18 years whose diagnostic and operation codes for DRFs were entered into the HIRA database, we analysed the incidence rates of and risk factors for CRPS-1. From 2007 to 2014, 172,194 DRFs were treated surgically. Within 1 year postoperatively, 1,103 CRPS-1 cases were diagnosed, with an incidence of 0.64%. On univariate and multivariate analyses, the risk factors that significantly correlated with the incidence of CRPS-1 included female sex, rheumatoid arthritis, open reduction, open fracture, and accompanying ulnar fracture, whereas old age, psychiatric disease, and external fixation were not statistically significant. The incidence of CRPS-1 after surgery for DRF was very low (0.64%) in South Korea. Careful monitoring is necessary for patients with complex fractures and rheumatoid arthritis who are at increased risk of developing CRPS-1.

Highlights

Most previous studies covered a small number of patients at single institutions, and there was no consensus on the diagnostic criteria for complex regional pain syndrome type 1 (CRPS-1)
Studies have suggested that treating distal radius fractures (DRFs) with external fixation (EF) increases the incidence of CRPS-1 compared with other surgical methods because of its long fixation period and distraction technique[15,16], whereas other studies have suggested that there is no significant difference in the incidence of CRPS-1 depending on the surgical method[17,18]
CRPS-1 occurred after surgery for DRF in 1,103 cases; the incidence rate was 0.64%

Summary

Introduction

Most previous studies covered a small number of patients at single institutions, and there was no consensus on the diagnostic criteria for CRPS-1. The incidence of CRPS-1 after DRF was significantly different amongst the studies, ranging from 0.9% to 37%4–7. Several studies have suggested that various risk factors are associated with the occurrence of CRPS-1, but there is disagreement amongst them on the relationship between these risk factors and the incidence of CRPS-18–10. Some studies have suggested that psychiatric disorders, such as depression and anxiety disorders, cause CRPS-111,12. Psychiatric disorders were not a trigger but a result of chronic pain and disability[13,14]. Studies have suggested that treating DRFs with external fixation (EF) increases the incidence of CRPS-1 compared with other surgical methods because of its long fixation period and distraction technique[15,16], whereas other studies have suggested that there is no significant difference in the incidence of CRPS-1 depending on the surgical method[17,18].

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