The Relation Between Reflex Sympathetic Dystrophy Syndrome and Trauma Severity in Patients With Distal Tibia Fracture

Background: Reflex sympathetic dystrophy (RSD) syndrome is a multifactorial disorder with clinical features of neurogenic inflammation that causes hypersensitivity to pain or severe allodynia as well as blood flow problems, swelling, skin discoloration and maladaptive neuroplasticity due to vasomotor disorders. Patients with major trauma are prone to homeostasis leading to inflammatory response syndrome and multiple organ distress syndrome. Several studies have investigated the etiology of this condition, but the cause remains unknown. The role of associated factors such as the limb immobilization technique and genetics has been reported in the development of this complication, but, so far, there is no information regarding the effect of trauma severity on the risk of RSD occurrence. Objectives: Given the importance of diagnosing and treating this condition, we aimed to study the effect of trauma severity on the prevalence of RSD. Patients and Methods: In this cross-sectional study, we examined patients with distal tibial fracture who visited Rasht Poursina hospital from ۲۰۱۰ to ۲۰۱۳. Exclusion criteria included associated fractures, underlying musculoskeletal diseases and mental and cognitive problems. To assess the severity of the initial injury in patients, the Hannover Fracture Scale ۹۸ (HFS۹۸) scoring checklist was used. The diagnosis of RSD was made on the basis of the IASP criterion. Demographic data, HFS۹۸ scores, and information regarding RSD prevalence were analyzed using SPSS version ۲۰. The Mann Whitney U nonparametric test was used for variables that were not normally distributed; the chi-square test was used to compare the qualitative variables. Results: Among the ۴۸۸ patients, ۲۹۲ (۵۹.۸۳%) were male. The mean age of the study population was ۴۴ ± ۹.۸۲ years. During the ۶- month follow-up, RSD occurred in ۴۵ patients, of whom ۲۸ (۶۲.۲۲%) were female and ۱۷ (۳۷.۷۷%) weremale; there was thus a significant difference in the prevalence of RSD in terms of gender (P = ۰.۰۰; chi square test). The mean HFS۹۸ score in patients without and with RSD was ۳.۰۸۱±۴.۰۸۳ and ۴.۰۸۰±۴.۶۲۲, respectively, and the difference was not statistically significant (P = ۰.۳۶۳; Mann Whitney U test). Analyses of the eight items of HFS۹۸ shows that local circulation in patients with RSD is significantly better than that in patients without RDS (۰.۶۸۳ ± ۰.۸۲۲ vs. ۰.۵۲۸ ± ۰.۶۲۹, respectively). Statistical analysis showed that the odds ratio for RSD for patients with HFS۹۵ score > ۰ was ۱.۰۷۹ (confidence interval [CI]: ۰.۸۹۸ - ۱.۳۳۳). Moreover, the odds ratio for RSD was ۱.۱۰۰ (CI: ۷۹۵ - ۱.۵۳۱) in patients with an injury severity score higher than the calculated mean score in patients without RSD (> ۴.۰۸۳). Conclusions: The results suggest no significant relationship between the severity of injury and risk of RSD occurrence, although themean injury severity score was higher in patients with RSD than in those without RSD in this study population. The lower score of local circulation in patients with RSD than in those without RSD is a statistically significant finding and can be attributed to changes in the antioxidant levels at the injury site, which is one of themainmechanisms for the onset of RSD. Wound contamination was also justifiably higher in patients with RSD, although the difference was not statistically significant. In summary, the severity of injury alone cannot be a determining factor for predicting the probability of RSD.

Keywords:

Reflex Sympathetic Dystrophy , RSD , CRPS۱ , Trauma , Tibia