Risk factors for complex regional pain syndrome after distal radius fracture following nonoperative management: A retrospective case-control study.

Abstract

Complex Regional Pain Syndrome (CRPS) is a painful and poorly understood condition often triggered by trauma, with diagnosis based on clinical criteria. Exploring and validating clinical risk factors is important for understanding susceptibility and guiding preventive strategies. In this retrospective case-control study included 112 nonoperatively managed distal radius fracture patients treated between 2015 and 2024, 56 diagnosed with CRPS Type 1 and 56 controls. Data on demographics, immobilization duration, and comorbidities were collected. Comparisons were performed with t-test/chi-square, and predictors were examined with logistic regression. Patients with CRPS were significantly older (54.8 ± 15.7 vs 35.8 ± 15.3 years, p < 0.001) and more often female (82 % vs 32 %, p < 0.001). Immobilisation was longer in CRPS patients (6.39 ± 0.80 vs 4.34 ± 0.79 weeks, p < 0.001). Immobilisation >5 weeks markedly increased risk (OR 26.9, 95 %CI 8.0-90.2, p < 0.001). ACE inhibitor use was also a strong independent risk factor (OR 10.2, 95 %CI 3.5-29.3, p < 0.001). Smoking was associated with lower risk (OR 0.41, 95 %CI 0.19-0.88, p = 0.022). BMI, side, and asthma/bronchitis were not significant. Older age, female sex, prolonged immobilisation, and ACE inhibitor use were independent predictors of CRPS after distal radius fracture. These findings emphasize the importance of limiting immobilisation and considering comorbidities in risk stratification.