JHS - 2026-04-03 - Journal Article
A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture.
Mungalpara NK, Reiser WK, Van Poucke L, Malhotra G, Mejia A, Gonzalez MH
Topics
Key Takeaway
Among 2,685,041 DRF patients, preexisting upper-limb nerve injury carries the highest CRPS risk (OR 3.20), while overall CRPS incidence was only 0.18%.
Summary Depth
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Summary
This study used the PearlDiver database to identify preinjury predictors of CRPS following DRF via 1:1 propensity score matching on age, sex, fracture type, and management, then applied multivariable logistic regression across 12 comorbidities. Neuropathic conditions were the dominant risk factors: upper-limb nerve injury OR 3.20, radial nerve lesions OR 2.43, cubital tunnel syndrome OR 2.27, and carpal tunnel syndrome OR 2.01. Psychiatric conditions (anxiety OR 1.25, fibromyalgia OR 1.58) conferred smaller but significant risk, while alcohol use was paradoxically protective (OR 0.86) and tobacco/cannabis were non-significant.
Key Limitation
CRPS diagnosis relies entirely on ICD coding accuracy within PearlDiver, with no validation against Budapest Criteria, creating substantial risk of both false-positive and false-negative case identification that could distort all reported odds ratios.
Original Abstract
PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognosis II.