Prevalence of Neuropathic Pain in Patients with Fracture of the Distal Extremity of the Radius Treated with Volar Locking Plate

Helbert Luiz Nomura da Silva; Giuliana Olivi Tanaka; Thiago Barros Pinheiro; Yussef Ali Abdouni

doi:10.1055/s-0041-1736526

Prevalence of Neuropathic Pain in Patients with Fracture of the Distal Extremity of the Radius Treated with Volar Locking Plate

Rev Bras Ortop (Sao Paulo). 2022 Jan 21;57(6):924-929. doi: 10.1055/s-0041-1736526. eCollection 2022 Dec.

Authors

Helbert Luiz Nomura da Silva¹, Giuliana Olivi Tanaka², Thiago Barros Pinheiro², Yussef Ali Abdouni³

Affiliations

¹ Médico Ex-residente do Grupo de Cirurgia da Mão e Microcirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
² Médico Residente de Ortopedia e Traumatologia do Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
³ Médico Assistente do Grupo de Cirurgia da Mão e Microcirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.

Abstract

Objective To evaluate the prevalence of persistent pain in the postoperative period of fractures of the distal extremity of the radius, as well as to detect early signs of neuropathic pain to develop protocols for the prevention of chronic postoperative pain. Methods Prospective study, carried out with 56 patients who underwent open reduction and internal fixation of fractures of the distal extremity of the radius with a volar locking plate from March to September 2020. The patients were submitted to assessment of neuropathic pain and functional capacity through the Douleur Neuropathique 4 questionnaire (DN4) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaires. Qualitative variables were compared using the Mann-Whitney U test and their correlation was analyzed using the Spearman Correlation and Equality of Two Proportions tests. Results A total of 43 patients aged between 18 and 66 years old were included in the present study; 39.5% of the participants scored ≥ 4 on the DN4 questionnaire. In relation to Quick-DASH, the average was 38.6. There was no statistically significant difference between the gender of the patient and the DN4 value ( p = 0.921). There was also no statistical correlation between the quantitative variables DN4 and Quick-DASH ( p = 0.061). Conclusions The prevalence of neuropathic pain in analyzed postoperative patients was significant, and the presence of signs and symptoms of neuropathic pain was a positive predictive factor for pain persistence beyond 2 months in 100% of cases. Thus, with early diagnosis of the neuropathic component of pain, associated with the nociceptive component, adequate pain control can be achieved, preventing its chronicity, and ensuring better rehabilitation.

Keywords: fracture fixation, internal; pain measurement; postoperative complications; radius fractures.

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