A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture
J Hand Surg Am. 2026 Apr 3:S0363-5023(26)00053-5. doi: 10.1016/j.jhsa.2026.01.004. Online ahead of print.
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.
PMID:41931087 | DOI:10.1016/j.jhsa.2026.01.004