[Posttraumatic dystrophy: the questionable value of early treatment]

The idea of early treatment for posttraumatic dystrophy (PD), although often cited in the literature and supported by clinical experience, is not based on convincing clinical evidence. The concept of PD is ill-defined and its diagnosis is based on variable criteria. Furthermore, scanty information about the natural course of early-diagnosed PD indicates that PD is partly self-limiting. Most important, however, is the lack of randomised placebo-controlled trials on different types of intervention. In studies without a control group, the effect of early therapy of a self-limiting disease is distorted: in case of early intervention there are relatively many patients with a milder form, whilst the more serious form predominates in case of late intervention. As a result of this patient selection, the results of therapy seem better or poorer, respectively, than would have been the case with a control group. Recent studies indicate that specific types of treatment may reduce the signs and symptoms of PD.