Session I - Upper Extremity

The Importance of Algoneurodystrophy in Different Treatment Options of Distal Radial Fractures

Daniel Stoffelen, MD; Paul L. O. Broos, PhD, Department of Traumatology, U.Z. Gasthuisberg, Leuven, Belgium

Purpose: The purpose of this study was to identify an early predictive factor of long-lasting algoneurodystrophy (Südeck-dystrophy) symptoms in different treatment options of distal radial fractures.

Methods: 272 dorsally displaced distal radial fractures were included in a randomised prospective trial.

All fractures were classified according to the Frykman classification and received the following treatment:

• Frykman I, II, IV and VI : closed reduction versus Kapandji pinning
• Frykman VII and VIII : plate fixation versus external fixation
• Minimally or undisplaced fractures, plaster treatment of one week compared to 3 weeks.

The occurrence of algoneurodystrophy was studied according to clinical evaluation consisting of rigidity of the fingers, a ready purple englased appearance of the skin and severe pain sensation with abnormal sweating.

All diagnoses were confirmed with an isotopic bonescan. Treatment consisted of Calsitonin 100 I.E. subcutaneously 5 days a week for 3 weeks and 3 days a week for another 3 weeks together with gentle physiotherapy.The Cooney score was used at 6 weeks, 3 months, 6 months and one year.

Results: From the 272 patients, 47 developed clear signs of algoneuro-dystrophy (14,4 % ) during a one-year follow-up period.After one year follow-up, only 10 patients still had discomfort from this disease (3,6 % ) .

Those patients who did not recover from the algoneurodystrophy had a significantly worse Cooney score at 6 weeks (16,5). All patients suffering from algoneurodystrophy had a significantly lower Cooney score compared to those with normal wrist and hand function. There was no statistical difference between the occurrence of algoneurodystrophy in Frykman type I and II compared to Frykman V, VII and VIII fractures. Frykman type V and VI, however, showed a significantly higher incidence (p = 0,005). According to treatment, only the plate fixation showed no algoneurodystrophy. All of the treatments had varying incidences where no differences could be found between closed reduction, Kapandji and external fixation.

Discussion and conclusion: Algoneurodystrophy seems to be a self-limiting disorder with simple treatment of Calsitonin and gentle physiotherapy. Only 3.6 % had remaining discomfort at one year follow-up following the distal radial fracture.

This therapy-resistent algoneurodystrophy was not treatment- nor fracture- type related but could be predicted from the initial Cooney at 6 weeks. It can therefore be concluded that it might be possible to predict the therapy resistence of algoneurodystrophy by the initial Cooney score at 6 weeks and the improvement up to 3 months. If the initial Cooney score is extremely low (< 30), early treatment of algoneurodystrophy can be considered.