[Reflex sympathetic dystrophy (Sudeck's disease). An unavoidable complication of distal radius fracture?]

Reflex sympathetic dystrophy after a distal radius fracture is judged as a complication, which cannot be avoided in every case. The aim of the present study is to find out whether this assumption also holds with respect to the actual technique of treatment of the radius fracture.

50 cases are analyzed, in which (between 1975 and 1996) an expert opinion was given about the question of malpractice.

In 3 of 50 cases malpractice due to healing of fracture in malposition was proven. Only in one case malpractice was seen in development of reflex sympathetic dystrophy itself. Although two thirds of the fractures were classified as instabile, 47 of them were treated conservatively. 30 of 40 repositions were incomplete from the beginning. In ten cases a second reposition was necessary, in 19 cases a secondary dislocation happened, 24 of 40 repositions were done without a sufficient analgesia. Most of the treatments would not follow the latest treatment principles of distal radius fracture.

The estimation of development of reflex sympathetic dystrophy has to be changed: This complication is to be regarded as inevitable only if the two most important triggers (instability and pain) are avoided by following the actual rules of treatments of the distal radius fracture.