A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture.

Abstract

Complex regional pain syndrome (CRPS) is an uncommon but debilitating complication following distal radius fractures (DRFs). This study aimed to evaluate a broad set of preexisting comorbidities, including substance-use disorders, psychiatric conditions, compressive neuropathies, upper-limb traumatic nerve injuries, and cervical radiculopathy and determine their associations with CRPS development after DRF. A retrospective analysis of the PearlDiver database (2010-2022) was performed. Patients with and without CRPS following DRF were matched 1:1 using propensity scores based on age, sex, fracture type, and DRF management (Current Procedural Terminology 25605-25609). Multivariable logistic regression evaluated the association between CRPS and 12 preexisting comorbidities. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) and P values were reported. Among 2,685,041 DRF patients, 3,796 developed CRPS (incidence 0.18%). In the matched cohort (n = 26,186), several strong associations emerged. Neuropathic conditions demonstrated the highest risk: upper-limb nerve injury (OR 3.20, 95% CI 2.42-4.30), radial nerve lesions (OR 2.43, 95% CI 1.72-3.50), cubital tunnel syndrome (OR 2.27, 95% CI 2.01-2.57), carpal tunnel syndrome (OR 2.01, 95% CI 1.88-2.14), and cervical radiculopathy (OR 1.80, 95% CI 1.68-1.94). Psychiatric conditions showed modest associations: anxiety disorders (OR 1.25, 95% CI 1.18-1.32), depression (OR 1.07, 95% CI 1.01-1.13), and fibromyalgia (OR 1.58, 95% CI 1.44-1.74). Substance-use factors demonstrated mixed effects: opioid use increased risk (OR 1.39, 95% CI 1.27-1.52), alcohol use decreased risk (OR 0.86, 95% CI 0.79-0.94), and tobacco/cannabis were not significant. Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after DRF. Psychiatric conditions confer a smaller but consistent risk, while substance-related factors vary. Identifying preexisting neural vulnerability may improve risk stratification after DRF. Prognosis II.