Complex regional pain syndrome in distal radius fractures: How to implement changes to reduce incidence and facilitate early management

Cowell, Fiona; Gillespie, Sharon; Cheung, Graham; Brown, D. J.

doi:10.1016/j.jht.2018.01.013

Cited by 11 publications

(12 citation statements)

References 9 publications

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“…Stiffness was identified in 20% of patients managed operatively versus 12% of patients managed non-operatively, which is a rate consistent with previous reports identifying stiffness as a complication of DRF management (Heyer et al., 2019; Ikpeze et al., 2016; Synn et al., 2009; Teunis et al., 2015). The incidence of chronic regional pain syndrome was more frequent with operative management, and the overall rate of 9.5% in this patient age cohort is in line with previous reports ranging from less than 1% to 25% (Cowell et al., 2018; Crijns et al., 2018; Farzad et al., 2018).…”

Section: Discussionsupporting

confidence: 91%

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

DeGeorge

Houten

Mwangi

et al. 2020

J Hand Surg Eur Vol

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To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III

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Section: Discussionsupporting

confidence: 91%

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

DeGeorge

Houten

Mwangi

et al. 2020

J Hand Surg Eur Vol

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“…Clinicians who feel frustrated, anxious or a perceived loss of autonomy when using guidelines were less likely to use them (3,40,47,49,53,57,(59)(60)(61). Furthermore, being afraid of missing information such as clinical signs or patient information, was also perceived as a barrier to use guidelines (3,49,53,54).…”

Section: Barriers Linked To Clinicians' Attitudes Towards Their Behaviormentioning

confidence: 99%

“…Furthermore, being afraid of missing information such as clinical signs or patient information, was also perceived as a barrier to use guidelines (3,49,53,54). The perception of a gap between the biopsychosocial model of care recommended by guidelines and their current practice (for example biomedical approach) (33,51,53,56,60,61), a culture of suspicion about guidelines (45), and a skeptical view of medicine or evidence-based practice (30,62) were identi ed as barriers of guideline utilization.…”

Section: Barriers Linked To Clinicians' Attitudes Towards Their Behaviormentioning

confidence: 99%

“…Moreover, authorities and public health policies could have an impact on clinicians perceiving guidelines as mandatory (45). Finally, long-term patients could also have an impact on guidelines' utilization; clinicians could be afraid to lose these patients if they do not satisfy their expectations (26,27,(60)(61)(62)(63).…”

Section: Barriers Included In Subjective Normsmentioning

confidence: 99%

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Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: A scoping review

Sorondo

Delpierre

Côté

et al. 2020

Preprint

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CONTEXT: Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence.AIM: To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs.METHOD: A scoping review of the literature was conducted. Three databases were searched from inception to December 2019. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles.RESULTS: 7667 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language.CONCLUSION: Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.

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“…10 According to the current literature, the incidence of CRPS-1 after nonoperatively treated DRFs ranges between 1% and 37%. [11][12][13][14] The difference in incidence can be explained by the lack of standardized and reproducible diagnostic criteria. 15,16 Harden et al validated the criteria to diagnose CRPS-1 at 3 months after the fracture, the socalled Budapest Criteria, which are now internationally accepted in clinical practice and research.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?

Ring

Meent

Klomp

et al. 2020

Hand (New York, N,Y.)

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Background: The optimal treatment for a distal radius fracture (DRF) remains an ongoing discussion. This study observed whether early activity postinjury can lead to the prevention of type 1 complex regional pain syndrome (CRPS-1). Method: Patients who underwent nonoperative treatment for a DRF were invited to participate in this study. Patients followed an exercise program with progressive loading exercises at home immediately after cast removal. After a minimum of 3 months, patients were interviewed by telephone to determine the presence of disproportionate pain. If present, the patients were seen during a clinical consultation to determine whether they had CRPS-1, using the Budapest Diagnostic Criteria. Results: Of the 129 patients included in this study, 12 reported disproportionate pain, and none were diagnosed with CRPS-1. The incidence of CRPS-1 was zero in this study. Conclusion: A more active treatment approach seems to lower the incidence of CRPS-1. A larger randomized study is necessary to strengthen the evidence.

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Complex regional pain syndrome in distal radius fractures: How to implement changes to reduce incidence and facilitate early management

Cited by 11 publications

References 9 publications

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: A scoping review

Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?

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