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Algodystrophy Following Colles’ Fracture
Abstract
The prevalence of algodystrophy in the hand was determined at nine weeks and six months following Colles’ fracture. At nine weeks, 27 of 109 patients showed signs of algodystrophy, all of whom demonstrated more than one feature of the disorder. Thereafter, no unaffected patient developed the disorder. At six months, 62% of the previously affected patients showed some residual abnormalities. In 66% of these, there was evidence of continuing vasomotor instability or swelling, suggesting that the syndrome was still active. These observations suggest that algodystrophy of the hand is a more common complication of Colles’ fracture than is generally realised.
Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder characterized by a diverse array of symptoms, including pain that is disproportionate to the initial triggering event, accompanied by autonomic, sensory, motor, and sudomotor disturbances. The primary pathology of both types of CRPS (Type I, also known as reflex sympathetic dystrophy, RSD; Type II, also known as causalgia) is featured by allodynia, edema, changes in skin color and temperature, and dystrophy, predominantly affecting extremities. Recent studies started to unravel the complex pathogenic mechanisms of CRPS, particularly from an autoimmune and neuroimmune interaction perspective. CRPS is now recognized as a systemic disease that stems from a complex interplay of inflammatory, immunologic, neurogenic, genetic, and psychologic factors. The relative contributions of these factors may vary among patients and even within a single patient over time. Key mechanisms underlying clinical manifestations include peripheral and central sensitization, sympathetic dysregulation, and alterations in somatosensory processing. Enhanced understanding of the mechanisms of CRPS is crucial for the development of effective therapeutic interventions. While our mechanistic understanding of CRPS remains incomplete, this article updates recent research advancements and sheds light on the etiology, pathogenesis, and molecular underpinnings of CRPS.
Complex regional pain syndrome (CRPS) is a debilitating painful condition of a distal extremity that can develop after tissue damage. CRPS is thought to be a multimechanism syndrome and ideally the most prominent mechanism(s) should be targeted by drugs in an individually tailored manner. This review gives an overview of the action and evidence of current and future pharmacotherapeutic options for CRPS. The available options are grouped in four categories by their therapeutic actions on the CRPS mechanisms, i.e. inflammation, central sensitisation, vasomotor disturbances and motor disturbances. More knowledge about the underlying mechanisms of CRPS helps to specifically target important CRPS mechanisms. In the future, objective biomarkers could potentially aid in selecting appropriate mechanism-based drugs in order to increase the effectiveness of CRPS treatment. Using this approach, current and future pharmacotherapeutic options for CRPS should be studied in multicentre trials to prove their efficacy. The ultimate goal is to shift the symptom-based selection of therapy into a mechanism-based selection of therapy in CRPS.
Amaç: Bu çalışmanın amacı, radius distal uç kırıklarında, intrafo-kal telleme (Kapandji) ve eksternal fiksatör (EF) tekniklerini, karşı-laştırmak, radyolojik olarak redüksiyon’un kalitesi, fonksiyonel sonuçlar ve hastanın subjektif görüşlerini değerlendirmektir.Materyal ve Metod: Yaş göz önüne alınmadan, birden fazla eklem içi kırık hattı olan çok parçalı kırıklar hariç, dorsale yer değiştirmiş radius distal uç kapalı kırığı ile başvuran 101 hasta değerlendirmeye alındı. 46 tanesi Kapandji, 55 tanesi EF ile tedavi edildiler.Bulgular: Post-op 3. haftada, Kapandji yöntemiyle tedavi edilen hastalarda ağrı daha belirgindi (p=0,049). Hareket sınırları, ulnar deviasyon hariç, 6. haftada Kapandji yöntemiyle tedavi edilenlerde daha iyidi (fleksiyon için p<0,001, ekstansiyon için p<0,001). Eklem içi kırıkların, cerrahi teknik göz önüne alınmadan, fonksi-yonel ilerleme (Hareket açıklığı, el sıkma kuvveti, günlük aktivite) üzerine etki etmediği görüldü. Sonuçlar 6. ayda benzer bulundu. El sıkma kuvvetinin geri kazanılması intrafokal telleme için 6. hafta (p=0,000) ve 3. Ayda (p=0,011) daha iyiydi.Sonuç: Her iki teknik ile elde edilen sonuçlar birbirine benzerdir. Bizce konsolidasyon süresi düşünülenden daha uzun sürmektedir. Acaba immobilizasyon süresinin biraz daha arttırılması veya telle-rin çıkarılmasının geciktirilmesi gerekmez mi? Ayrıca, kemik grefti, önemli dorsal çok parçalanma olan kırıklarda radyolojik sonuçları iyileştirecek bir çözüm olabilir.
Two hundred and thirty-five patients with displaced Colles' fractures were followed to union, and 209 patients to six months, specifically searching for hand pathology.
The incidence of carpal tunnel syndrome was seventeen per cent at three months and twelve per cent at six months. The patients with the syndrome were significantly older and their fractures showed significantly greater residual dorsal angulation.
Sixteen patients developed Dupuytren's disease between three and six months, when the incidence was eleven per cent. These patients were significantly older and had average fractures and anatomical results. All cases were mild, with only two contractures. Twenty-one patients were reviewed at a mean of 20.7 months post-fracture, when no case had significantly progressed.
1. A prospective study of 239 Colles's fractures was made.
2. This indicates that all displaced Colles's fractures should be reduced.
3. After reduction a below-elbow plaster should be used.
4. An above-elbow plaster has no advantages and may have some disadvantages.
Of the various methods for measuring pain the visual analogue scale seems to be the most sensitive. For assessing response to treatment a pain-relief scale has advantages over a pain scale. Pain cannot be said to have been relieved unless pain or pain relief has been directly measured.
1. The incidence of Sudeck's syndrome in the hand is about once in 2,000 accidents of all kinds.
2. The onset of signs and symptoms occurs some weeks after injury and the typical radiographic changes (spotty atrophy) appear six to eight weeks later.
3. Conservative treatment by heat, elevation and graded function is effective if initiated within six weeks of the onset of symptoms.
4. There is some close relationship between Sudeck's atrophy and thickening of the palmar fascia.