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

Alejandro Lorente; Gonzalo Mariscal; Rafael Lorente

doi:10.1007/s00402-023-04909-8

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

Arch Orthop Trauma Surg. 2023 Sep;143(9):5687-5699. doi: 10.1007/s00402-023-04909-8. Epub 2023 May 20.

Authors

Alejandro Lorente¹, Gonzalo Mariscal^{2

3}, Rafael Lorente⁴

Affiliations

¹ Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, Madrid, Spain.
² Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Carrer de Quevedo, 2, 46001, València, Valencia, Spain. Gonzalo.mariscal@mail.ucv.es.
³ Mediterranean Observatory for Clinical and Health Research, Valencia, Spain. Gonzalo.mariscal@mail.ucv.es.
⁴ Department of Orthopedic Surgery and Traumatology, University Hospital of Badajoz, Badajoz, Spain.

PMID: 37209231
DOI: 10.1007/s00402-023-04909-8

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.

Keywords: CRPS; Complex regional pain syndrome; Distal radius fracture; Meta-analysis; Radial head fracture.

Publication types

Meta-Analysis
Review

MeSH terms

Comorbidity
Complex Regional Pain Syndromes* / complications
Complex Regional Pain Syndromes* / etiology
Female
Humans
Incidence
Male
Open Fracture Reduction / adverse effects
Radius Fractures* / complications
Radius Fractures* / epidemiology
Radius Fractures* / surgery