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Complex Regional Pain Syndrome Following Distal Radius Fracture: Does Surgical Method Matter?

Trine Ludvigsen^1,2, Ola-Lars Hammer³, Jonas Meling Fevang^1,4

¹Faculty of Medicine, University of Bergen, Norway.

Journal of Wrist Surgery

|November 21, 2025

Summary

Surgical treatment for distal radius fractures (DRFs) using external fixators (EF) carries a higher risk of complex regional pain syndrome (CRPS) compared to volar locking plates (VLP). No other factors predicted CRPS development.

Keywords:

Budapest criteria complex regional pain syndrome distal radius fracture external fixator volar locking plate

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Area of Science:

Orthopedic surgery
Pain management
Trauma care

Background:

Distal radius fractures (DRFs) are common injuries.
Surgical interventions aim to restore function and reduce pain.
Complex regional pain syndrome (CRPS) is a potential complication following DRF treatment.

Purpose of the Study:

To compare the incidence of complex regional pain syndrome (CRPS) after surgical fixation of distal radius fractures (DRFs).
To evaluate the risk of CRPS associated with volar locking plate (VLP) versus external fixator (EF) treatment for DRFs.

Main Methods:

Pooled data from two randomized controlled trials (RCTs) involving 322 patients.
Logistic regression analysis to identify independent risk factors for CRPS.
Comparison of CRPS rates between VLP (159 patients) and EF (163 patients) groups.

Main Results:

Overall CRPS incidence was 7% (22/322 patients).
CRPS occurred in 4% (6/159) of patients treated with VLP.
CRPS occurred in 11% (16/163) of patients treated with EF.
The difference in CRPS rates between VLP and EF was statistically significant (p < 0.05).

Conclusions:

External fixator (EF) use for DRFs is associated with a significantly higher risk of developing complex regional pain syndrome (CRPS) compared to volar locking plates (VLP).
No other independent variables were found to predict CRPS development in this cohort.