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The early diagnosis of post-traumatic reflex sympathetic dystrophy
64
THE .IOURNAL
SESSION 120. THE EARLY DIAGNOSIS SYMPATHETIC
OF POST-TRAUMATIC
REFLEX
DYSTROPHY
Andrzcj Zyluk, Piotr Puchalski. Department of Gene& and Hand Surgery, Pomerunian Academy oj’hfedicine, ul. Unii Lubelskiqj I, 71-252 Szczecin, Poland Objectives: To determine how soon after trauma the diagnosis of reflex sympathetic dystrophy (RSD) can be made. Materials and methods: A rctrospcctivc analysis was looking at sequence of symptoms and signs recorded in 64 patients who developed RSD following trauma or operation. The following features were noted: diffuse pain, swelling, reduction of finger movement, temperature change and colour change. Based on these recordings, we determine how soon after injury/operation a set of features sufficient to make the diagnosis could be detected. Results: It was found that the set of features to make a diagnosis of RSD were present at 1 week in 22 patients (34%), at 2 weeks in 37 (58%), at 3 weeks in 46 (72%) and at 4 weeks in 53 patients (83%). Only in 11 patients (17%) did the features appear later than 1 month after the initial trauma. The syndrome had been recorded in the contemporaneous records as eventually diagnosed at 1 month only in 20 patients (31%). The traditional view of the RSD as a ‘chronic’ pain syndrome probably caused delay in the diagnosis in 707~ of these patients. Conclusion: The results show that RSD can be diagnosed as early as at lmonth after initial trauma. Early diagnosis may allow treatment to prevent development of a florid condition and aid recovery.
121. QUANTITATIVE SCINTIGRAPHY POST-TRAUMATIC
EVALUATION
OF THREE PHASE BONE
BEFORE AND AFTER THE TREATMENT REFLEX SYMPATHETIC
OF
DYSTROPHY
Andrzej Zyluk. Depurttnent of Geneml and Hund Surgery and Department ofNuclear Medicine Ponzeranian Academy of Medicine, ~1. Unii Lubelskiej I, 71-252 Szczecin, Poland Objectives: Three phase skeletal scintigraphy was performed in 65 patients with post-traumatic reflex sympathetic dystrophy (RSD) in order to evaluate: a) which changes in uptake of the tracer appear before and after the treatment of the condition, b) which methods of treatment affect the intensity of uptake and c) to investigate correlation between results of the treatment and intensity of the uptake both at initial and tinal scintigraphic examinations. Material and methods: 49 patients were treated by three methods; sixteen patients were observed without treatment. Skeletal scintigraphy was performed twice in each patient: before the treatment/observation and at the final assessment (6 to 18 months after the treatment). Clinical results were rated as good, moderate or poor. Scintigrams were evaluated quantitatively after processing. Results: A significant reduction of the initially increased uptake of the tracer was noted in each phase/region of interest 6-18 months after initial imaging. At final assessment, mean uptake ratios in treated and non-treated patients were similar. Thus indicates that
OF HAN11 SURGERY
VOL.
2XH SUPPLEMENT
I
15: RSD the trcatmcnt did not affect the rate of reduction of isotope uptake. In patients with good and moderate results of treatment, mean uptake ratios at initial scanning wcrc significantly higher, than in those, with poor outcome. It indicates that three phase bone scintigraphy may have prognostic value in RSD: marked hypertixation of the tracer indicates bcttcr final outcome. Howcvcr, at final imaging, mean uptake ratios in patients with good, moderate and poor result of the treatment were not significantly different. Conclusion: This study suggests that three phase bone scintigraphy has no value in monitoring the course of treatment of RSD.
122. VITAMIN C AND PREVENTION OF REFLEX SYMPATHETIC DYSTROPHY IN CASE OF SURGICAL PROCEDURE FOR FRACTURE OF THE DISTAL RADIUS F. Kermad, J.F. Cazeneuve, B. Rihane, Y. Hassan, J.M. Leborgne. Institutiolz/Hospital,: Centre Hospitalier Lam, Avenue Marcellin 02,: Lam, France
de
Introduction: The authors present a prospective review of 185 fractures of the distal radius, while underwent closed reduction and intrafocal pinning plus prescription of ascorbic acid (Vitamin C) in order to prevent reflex sympathetic dystrophy (P. Zollinger, Lancet - vo1354 - 1999). Materials and methods: Between January 1995 and October 2001, two groups of patients with displaced fractures of the distal radius underwent operative treatment by Kapandji’s intra focal pinning. The first group, 100 patients, 68 females and 32 males, average age 54 years (range 17 to 90) underwent surgical procedure without prescription of Vitamin C. 58 cases were extra-articular and 8 complex intra articular. The second group, 85 patients, 62 females and 23 males, average age 57 years (range 17 to 92) underwent the same surgical procedure. 22 cases were extra-articular and 8 complex intra-articular. This group received a 45 day course of Vitamin C (1 g each morning). All patients were examined clinically and radiographically 10, 20, 30 and 90 days after surgery. The pins were removed after 30 days. Results: In the first group, the complications were : reflex sympathetic dystrophy (6 women and 3 males) 970, secondary displacement 12%, stiffness lo/o, perforation of the skin by the pin 3%, tear of the tendon of the flexor pollicis longus 1%. In the second group, there were two cases (2.35%~) of reflex sympathetic dystrophy (2 females), and other complications were comparatively the same as the first group. Conclusion: Vitamin C appears to be a reliable treatment in order to reduce the incidence of reflex sympathetic dystrophy in operated wrist fractures. On going prospective studies will provide new data to confirm this.
THE .IOURNAL
SESSION 120. THE EARLY DIAGNOSIS SYMPATHETIC
OF POST-TRAUMATIC
REFLEX
DYSTROPHY
Andrzcj Zyluk, Piotr Puchalski. Department of Gene& and Hand Surgery, Pomerunian Academy oj’hfedicine, ul. Unii Lubelskiqj I, 71-252 Szczecin, Poland Objectives: To determine how soon after trauma the diagnosis of reflex sympathetic dystrophy (RSD) can be made. Materials and methods: A rctrospcctivc analysis was looking at sequence of symptoms and signs recorded in 64 patients who developed RSD following trauma or operation. The following features were noted: diffuse pain, swelling, reduction of finger movement, temperature change and colour change. Based on these recordings, we determine how soon after injury/operation a set of features sufficient to make the diagnosis could be detected. Results: It was found that the set of features to make a diagnosis of RSD were present at 1 week in 22 patients (34%), at 2 weeks in 37 (58%), at 3 weeks in 46 (72%) and at 4 weeks in 53 patients (83%). Only in 11 patients (17%) did the features appear later than 1 month after the initial trauma. The syndrome had been recorded in the contemporaneous records as eventually diagnosed at 1 month only in 20 patients (31%). The traditional view of the RSD as a ‘chronic’ pain syndrome probably caused delay in the diagnosis in 707~ of these patients. Conclusion: The results show that RSD can be diagnosed as early as at lmonth after initial trauma. Early diagnosis may allow treatment to prevent development of a florid condition and aid recovery.
121. QUANTITATIVE SCINTIGRAPHY POST-TRAUMATIC
EVALUATION
OF THREE PHASE BONE
BEFORE AND AFTER THE TREATMENT REFLEX SYMPATHETIC
OF
DYSTROPHY
Andrzej Zyluk. Depurttnent of Geneml and Hund Surgery and Department ofNuclear Medicine Ponzeranian Academy of Medicine, ~1. Unii Lubelskiej I, 71-252 Szczecin, Poland Objectives: Three phase skeletal scintigraphy was performed in 65 patients with post-traumatic reflex sympathetic dystrophy (RSD) in order to evaluate: a) which changes in uptake of the tracer appear before and after the treatment of the condition, b) which methods of treatment affect the intensity of uptake and c) to investigate correlation between results of the treatment and intensity of the uptake both at initial and tinal scintigraphic examinations. Material and methods: 49 patients were treated by three methods; sixteen patients were observed without treatment. Skeletal scintigraphy was performed twice in each patient: before the treatment/observation and at the final assessment (6 to 18 months after the treatment). Clinical results were rated as good, moderate or poor. Scintigrams were evaluated quantitatively after processing. Results: A significant reduction of the initially increased uptake of the tracer was noted in each phase/region of interest 6-18 months after initial imaging. At final assessment, mean uptake ratios in treated and non-treated patients were similar. Thus indicates that
OF HAN11 SURGERY
VOL.
2XH SUPPLEMENT
I
15: RSD the trcatmcnt did not affect the rate of reduction of isotope uptake. In patients with good and moderate results of treatment, mean uptake ratios at initial scanning wcrc significantly higher, than in those, with poor outcome. It indicates that three phase bone scintigraphy may have prognostic value in RSD: marked hypertixation of the tracer indicates bcttcr final outcome. Howcvcr, at final imaging, mean uptake ratios in patients with good, moderate and poor result of the treatment were not significantly different. Conclusion: This study suggests that three phase bone scintigraphy has no value in monitoring the course of treatment of RSD.
122. VITAMIN C AND PREVENTION OF REFLEX SYMPATHETIC DYSTROPHY IN CASE OF SURGICAL PROCEDURE FOR FRACTURE OF THE DISTAL RADIUS F. Kermad, J.F. Cazeneuve, B. Rihane, Y. Hassan, J.M. Leborgne. Institutiolz/Hospital,: Centre Hospitalier Lam, Avenue Marcellin 02,: Lam, France
de
Introduction: The authors present a prospective review of 185 fractures of the distal radius, while underwent closed reduction and intrafocal pinning plus prescription of ascorbic acid (Vitamin C) in order to prevent reflex sympathetic dystrophy (P. Zollinger, Lancet - vo1354 - 1999). Materials and methods: Between January 1995 and October 2001, two groups of patients with displaced fractures of the distal radius underwent operative treatment by Kapandji’s intra focal pinning. The first group, 100 patients, 68 females and 32 males, average age 54 years (range 17 to 90) underwent surgical procedure without prescription of Vitamin C. 58 cases were extra-articular and 8 complex intra articular. The second group, 85 patients, 62 females and 23 males, average age 57 years (range 17 to 92) underwent the same surgical procedure. 22 cases were extra-articular and 8 complex intra-articular. This group received a 45 day course of Vitamin C (1 g each morning). All patients were examined clinically and radiographically 10, 20, 30 and 90 days after surgery. The pins were removed after 30 days. Results: In the first group, the complications were : reflex sympathetic dystrophy (6 women and 3 males) 970, secondary displacement 12%, stiffness lo/o, perforation of the skin by the pin 3%, tear of the tendon of the flexor pollicis longus 1%. In the second group, there were two cases (2.35%~) of reflex sympathetic dystrophy (2 females), and other complications were comparatively the same as the first group. Conclusion: Vitamin C appears to be a reliable treatment in order to reduce the incidence of reflex sympathetic dystrophy in operated wrist fractures. On going prospective studies will provide new data to confirm this.