[Acute CRPS I (morbus sudeck) following distal radial fractures--methods for early diagnosis]

CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult. The incidence of CRPS I in patients at risk and the diagnostic value of clinical evaluation, radiography and thermography in the early posttraumatic phase are analysed.

158 consecutive patients with distal radial fractures were followed-up for 16 weeks after trauma. Apart from a detailed clinical examination 8 and 16 weeks after trauma, thermography and bilateral radiographs of both hands were performed.

At the end of the observation period 18 patients (11%) were clinically identified as CRPS I. The severity of the preceding trauma and the chosen therapy did not influence the process of the disease. 16 weeks after trauma easy differentiation between normal fracture patients and CRPS I patients was possible. 8 weeks after distal radial fracture clinical evaluation showed a sensitivity of 78% and a specificity of 94%. Thermography (58%) however and bilateral radiography (33%) revealed a poor sensitivity, respectively. The specificity was high for radiography (91%) and again poor for thermography (66%), respectively.

The results of the study support the importance of clinical evaluation in the early diagnosis of CRPS I. Plain radiographs facilitate the diagnosis as soon as bony changes develop.