Algodystrophy (CRPS) in minor orthopedic surgery

Abstract

Algodystrophy or Chronic Regional Pain Syndrome (CRPS) is a painful disorder that develops especially at upper or lower extremities of the limbs after a fracture. This syndrome is probably due to bone microvascular changes with subsequent sympathetic nervous system involvement. The pain that characterizes CRPS is spontaneous, disproportionate to the traumatic event and is associated with hyperalgesia, and a variety of autonomic and trophic disorders. This condition has a variable incidence up to 37% of the cases, increasing along with the severity of the fracture. CRPS has a higher chance of developing in women, in older individuals, in smokers, and in patients with reduced bone strength. Early diagnosis is associated with remission in 80-90% of cases. Since the typical onset of the disease is insidious over 2 weeks after surgery, a diagnostic and therapeutic delay may occur. These are the major causes of a high percentage of chronic and disabling complications leading to impaired functional outcomes. In the acute or subacute phase, infusion of bisphosphonates has proven to be the first-choice of treatment with a high percentage of remissions. Moreover, it has been suggested the utility of vitamin C in prevention of CRPS. Furthermore, in the chronic phase electroanalgesia seems to provide promising results.

Awareness of complex regional pain syndrome among medical professionals

“…12 This delay in diagnosis is the major cause of a high percentage of chronic pain and complication of functional impairment. 5 It has also been reported that early diagnosis associated with remission in 80%-90% of the cases. 12 Our study included 6 questions that were used to assess the awareness about CPRS, with 4 questions were only for those who have seen this condition before and used diagnostic criteria.…”

“…Many epidemiological studies showed high incidence of this condition in female patients. The incidence of CRPS increases exponentially with age 5,6,9 . Risk of the smoker, patients with low bone mineral density (BMD) and individuals with pre‐existing anxiety or depression also have been reported 5 .…”

“…4 Clinical symptoms may vary among different patients, and it is also variable on the same patients at different times. 5 Moreover, the onset of symptoms for the majority occurs within one month of the trauma or immobilization. Pain is the most important clinical symptom in CRPS, and it is usually permanent or fluctuated and mostly in deep tissue.…”

“…6 Edema is one of the vascular dysfunction symptoms that mostly develop in the acute phase. 5,7 CRPS usually displays differently in temperature when comparing both sides. 6 It is still not clear why some patients develop CRPS while others would not, despite the similar initiating event.…”

“…5,6,9 Risk of the smoker, patients with low bone mineral density (BMD) and individuals with pre-existing anxiety or depression also have been reported. 5 Some studies show that there might be some genetic predisposition and psychological factors to this condition. 10 Due to disease complexity and a broad spectrum of symptoms, CRPS is usually managed by physicians from different specialties including orthopedic surgeons, anesthesiologist, neurologist, rheumatologist, and rehabilitation physician.…”