The development of complex regional pain syndrome following distal radius fracture with or without concomitant carpal tunnel release

Retrospective cohort.

Complex regional pain syndrome (CRPS) is a rare but debilitating complication that may develop following distal radius fracture (DRF). Concomitant nerve-related injury may increase risk. The current study aimed to evaluate the incidence and odds of developing CRPS following DRF with or without need for open reduction and internal fixation (ORIF) and/or carpel tunnel release (CTR).

Unilateral DRF patients between 2010-2022 were abstracted from the PearlDiver M170 Ortho database. Cohorts were defined as: (1) DRF managed non-operatively, (2) DRF treated with ORIF without same-day CTR, and (3) DRF treated operatively with ORIF and same-day CTR. ICD-10 laterality coding was used to ensure side-specific matching of DRF and CRPS diagnoses. Management cohorts were matched 1:1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI). Monthly incidence of CRPS diagnosis through 1-year post-injury was determined for each matched cohort. Multivariable regression was performed to identify factors independently associated with CRPS.

After matching, there were 7656 patients in each management cohort. At 1 year, the incidence of CRPS was 24 (0.31 %) in the non-operative group, 44 (0.57 %) in the ORIF-only group, and 110 (1.44 %) in the ORIF+CTR group. Compared with non-operative management, ORIF-only was associated with an odds ratio for CRPS of 2.19 at 3 months and 1.84 at 1 year, while ORIF+CTR demonstrated an odds ratio for CRPS of 6.42 at 3 months and 4.60 at 1 year. A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73).

Patients undergoing ORIF with concomitant CTR demonstrated the highest odds of CRPS at both early and late timepoints, likely related to median nerve injury or irritation at the time of injury in cases requiring acute CTR.

III.