Radiological criteria to predict complex regional pain syndrome in distal radial fractures: A preliminary report

Complex Regional Pain Syndrome is known complication of distal radial fractures. At present we have no radiological criteria to predict it. This was a prospective and retrospective observational study done on 72 patients with follow up of 1 year. The patients were divided in two groups on the basis of Effective Radio lunate flexion < 25deg (midcarpal instability) and >25deg (radiocarpal instability). The results showed that the loss of radial tilt, loss of radial length, restriction of pronation and supination was high in midcarpal instability group. The same group has high incidence of CRPS. We can conclude that midcarpal instability is due to high severity of trauma which may be one of the causes of complex regional pain syndrome. Also the group treated by manipulation and cast has high risk of complex regional pain syndrome. We recommend carpal instability to be kept in mind while deciding treatment in distal end radial fractures. Patients with midcarpal instability should preferably be treated by open reduction and fixation with early mobilisation.