Fracture of the Wrist and Incidence of the Complex Regional Pain Syndrome Type 1: A Case Series Study

  • Payam vezvaei Medical Doctor, Sina trauma and surgery research center, Tehran university of medical sciences, Tehran, Iran
  • Soroosh Alizadeh Medical Doctor, School of medicine, Tehran university of medical sciences, Tehran, Iran
  • Saeed Reza mehrpour Associate Professor, Orthopedic department, Shariati Hospital, Tehran university of medical sciences, Tehran, Iran
  • Leila Oryadi Zanjani Mail Assistant professor, Orthopedic department, Shariati Hospital, Tehran university of medical sciences, Tehran, Iran
Complex regional pain syndrome, Upper Extremity; Incidence


Background: Complex regional pain syndrome (CRPS) is a painful syndrome with signs such as swelling, restriction of motion, and discoloration of the skin and bone. CRPS is divided into two types based on neurological injuries. Type 1 CRPS (CRPS-I), which is more common, has no nerve damage. In this study, we used the Budapest Criteria to investigate the incidence of CRPS. We also evaluated the risk factors for the incidence of CRPS.

Methods: This single-center case series study was performed at Shariati Hospital of Tehran University of Medical Sciences, Tehran, Iran, during 2018-2019. We evaluated CRPS-I, two, and six weeks after treatment based on Budapest Criteria. The inclusion criteria included distal radius fracture confirmed by clinical and radiographic investigations. The exclusion criteria were patients with fractures in another part of the body, associated nerve damage, vascular injury, and an open fracture.

Results: Sixty-two patients with distal radius fracture who underwent casting or surgical treatment enrolled in the study. A total of 9 (14.5%) patients had CRPS-I after distal radius fracture. In 5 (8.1%) patients, CRPS-I occurred within two weeks after fracture. Also, 4 (6.5%) patients had CRPS-I after six weeks from fracture. There was no significant difference between the two sex groups in terms of CRPS (P = 0.345). This complication was significantly higher in the surgical group than in the casting group (P = 0.004).

Conclusions: Given the significant incidence of CRPS and its impact on patient's quality of life, further studies are recommended to explore solutions to reduce this complication.



1. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma. 2015;29(8):e242-e244. doi: 10.1097/BOT.0000000000000312. [PubMed: 25714441].

2. Galer BS, Jensen M. Neglect-like symptoms in complex regional pain syndrome: Results of a self-administered survey. J Pain Symptom Manage. 1999;18(3):213-7. doi: 10.1016/s0885-3924(99)00076-7. [PubMed: 10517043].

3. de Mos M, Sturkenboom MC, Huygen FJ. Current understandings on complex regional pain syndrome. Pain Pract. 2009;9(2):86-99. doi: 10.1111/j.1533-2500.2009.00262.x. [PubMed: 19215592].

4. Galer BS, Henderson J, Perander J, Jensen MP. Course of symptoms and quality of life measurement in Complex Regional Pain Syndrome: A pilot survey. J Pain Symptom Manage. 2000;20(4):286-92. doi: 10.1016/s0885-3924(00)00183-4. [PubMed: 11027911].

5. Jellad A, Salah S, Ben Salah FZ. Complex regional pain syndrome type I: Incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil. 2014;95(3):487-92. doi: 10.1016/j.apmr.2013.09.012. [PubMed: 24080349].

6. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8(4):326-31. doi: 10.1111/j.1526-4637.2006.00169.x. [PubMed: 17610454].

7. Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: Prospective study of 829 patients. Lancet. 1993;342(8878):1012-6. doi: 10.1016/0140-6736(93)92877-v. [PubMed: 8105263].

8. Bruehl S, Harden RN, Galer BS, Saltz S, Backonja M, Stanton-Hicks M. Complex regional pain syndrome: Are there distinct subtypes and sequential stages of the syndrome? Pain. 2002;95(1-2):119-24.doi:10.1016/s0304-3959(01)00387-6.[PubMed: 11790474].

9. Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-74. doi: 10.1016/j.pain.2010.04.030. [PubMed: 20493633]. [PubMed Central: PMC2914601].

10. Beerthuizen A, Stronks DL, Van't Spijker A, Yaksh A, Hanraets BM, Klein J, et al. Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): Prospective study on 596 patients with a fracture. Pain. 2012;153(6):1187-92. doi: 10.1016/j.pain.2012.01.026. [PubMed: 22386473].

11. Zyluk A. Complex regional pain syndrome type I. Risk factors, prevention and risk of recurrence. J Hand Surg Br. 2004;29(4):334-7. doi: 10.1016/j.jhsb.2004.01.003. [PubMed: 15234496].

12. Roh YH, Lee BK, Noh JH, Baek JR, Oh JH, Gong HS, et al. Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg. 2014;134(12):1775-81. doi: 10.1007/s00402-014-2094-5. [PubMed: 25311113].

13. Dijkstra PU, Groothoff JW, ten Duis HJ, Geertzen JH. Incidence of complex regional pain syndrome type I after fractures of the distal radius. Eur J Pain. 2003;7(5):457-62. doi: 10.1016/s1090-3801(03)00015-6. [PubMed: 12935798].

14. Zollinger PE, Kreis RW, van der Meulen HG, van der Elst M, Breederveld RS, Tuinebreijer WE. No higher risk of CRPS after external fixation of distal radial fractures-subgroup analysis under randomised vitamin C prophylaxis. Open Orthop J. 2010;4:71-5. doi: 10.2174/1874325001004020071. [PubMed: 20309405]. [PubMed Central: PMC2842945].

15. Tajerian M, Sahbaie P, Sun Y, Leu D, Yang HY, Li W, et al. Sex differences in a Murine Model of Complex Regional Pain Syndrome. Neurobiol Learn Mem. 2015;123:100-9. doi: 10.1016/j.nlm.2015.06.004. [PubMed: 26070658]. [PubMed Central: PMC4530062].

16. de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: A population-based study. Pain. 2007;129(1-2):12-20. doi: 10.1016/j.pain.2006.09.008. [PubMed: 17084977].

17. Sumitani M, Yasunaga H, Uchida K, Horiguchi H, Nakamura M, Ohe K, et al. Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: Data from the Japanese Diagnosis Procedure Combination database. Rheumatology (Oxford). 2014;53(7):1186-93.doi:10.1093/rheumatology/ket431. [PubMed: 24369418].

18. Ratti C, Nordio A, Resmini G, Murena L. Post-traumatic complex regional pain syndrome: Clinical features and epidemiology. Clin Cases Miner Bone Metab. 2015;12(Suppl 1):11-6. doi: 10.11138/ccmbm/2015.12.3s.011. [PubMed: 27134626]. [PubMed Central: PMC4832405].
How to Cite
vezvaei P, Alizadeh S, mehrpour SR, Oryadi Zanjani L. Fracture of the Wrist and Incidence of the Complex Regional Pain Syndrome Type 1: A Case Series Study. J Orthop Spine Trauma. 4(4):71-73.
Research Articles