Perioperative Factors Affecting the Occurrence of Acute Complex Regional Pain Syndrome Following Limb Bone Fracture Surgery: Data from the Japanese Diagnosis Procedure Combination Database. 

SLR- March 2014- Carly Kriedberg

Reference: Sumitani; N. Yasanuga; H. Uchida; K. Horiguchi; H. Nakamura; M. Ohe; K, Fushimi; K, Matsuda; S. Yamada; Y. Rheumatology (Oxford). 2013 Dec 24.

Reviewed by: Carly Kriedberg, DPM
Residency Program: Botsford Hospital

Podiatric Relevance: Chronic regional pain syndrome (CRPS) is a chronic pain condition most often affecting one of the limbs usually after acute injury. Podiatric physicians should be aware of the current concepts and results regarding this often painful and challenging diagnosis. The authors of this article were trying to specify the demographic and medical factors that most likely constitute a risk of developing CRPS and to search for potential interventions to reduce the occurrence of CRPS in limb fracture patients. 


Methods: Using the Japanese Diagnosis Procedure Combination Database, the authors identified thirty nine patients that were diagnosed with CRPS following ORIF for limb fractures in a cohort of 185,378 inpatients. The patients were treated with ORIF between the months of July and December of years 2007-2010. Clinical data and patient information characteristics such as age, gender, fracture site, duration of anesthesia and use of regional anesthesia were investigated by logistic regression analysis to examine the associations between these factors and the in-hospital occurrence of complex regional pain syndrome after ORIF.

Results: The occurrence of CRPS was relatively high in fractures of the distal forearm and low infractures of the lower limb. Generally speaking statistics have shown that females are at higher risk of developing CRPS. In this study the authors found a comparable number of male and female patients suffering from CRPS after ORIF from limb fracture. They also discovered that a longer duration of anesthesia, while not regional anesthesia, was significantly associated with a higher incidence of CRPS.

Conclusion: While only 39 CRPS patients were evaluated in this study, it’s important that reducing operating time may help prevent the development of acute CRPS following limb fracture. This article was extremely important for me to read as a young podiatric physician. I came to realize that CRPS can be a very difficult diagnosis to treat and that it is crucial to understand the signs, symptoms and patient characteristics that may predispose one to developing CRPS post ORIF of a limb fracture. The underlying pathophysiology of the disease is still very controversial but this article did an excellent job of setting up possible explanations; one mentioned was neuropathic pain. I was overall surprised to read that multiple fractures carried a relatively low association with CRPS. The authors also speculated that a longer inflation period with a tourniquet on and exposed limb may be the cause of CRPS.