A Scola1, E Scola. 1. Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert Einstein Allee 23, Ulm, Germany. alexander.scola@uniklinik-ulm.de
Abstract
BACKGROUND: Posttraumatic dystrophy manifests as signs and symptoms of endothelial dysfunction in the microcirculation with pronounced involvement of arteriovenous (AV) anastomosis. PATIENTS AND METHODS: Blood gas analysis was performed in 28 patients with persistent painful swelling 6-14 weeks after distal radius fracture or hand injury. The patients showed higher levels of venous oxygenation on the affected side in comparison to the contralateral arm. Furthermore, an increased perfusion and an AV shunt situation were proven by radionuclide angiography. These findings correlate with insufficient oxygen utilization by the tissue (dystrophy = capillary malperfusion). Pathophysiologically, complex processes must be assumed which require a multimodal therapy and treatment focuses on open AV shunts. RESULTS: The disastrous consequences of hand dystrophy (loss of function due to fibrosis) could be prevented in all patients. Statistical analyses between affected and normal hands showed significant differences. CONCLUSION: Posttraumatic dystrophy needs early detection for successful therapy and should not be identified under the umbrella term "complex regional pain syndrome" (CRPS).
BACKGROUND:Posttraumatic dystrophy manifests as signs and symptoms of endothelial dysfunction in the microcirculation with pronounced involvement of arteriovenous (AV) anastomosis. PATIENTS AND METHODS: Blood gas analysis was performed in 28 patients with persistent painful swelling 6-14 weeks after distal radius fracture or hand injury. The patients showed higher levels of venous oxygenation on the affected side in comparison to the contralateral arm. Furthermore, an increased perfusion and an AV shunt situation were proven by radionuclide angiography. These findings correlate with insufficient oxygen utilization by the tissue (dystrophy = capillary malperfusion). Pathophysiologically, complex processes must be assumed which require a multimodal therapy and treatment focuses on open AV shunts. RESULTS: The disastrous consequences of hand dystrophy (loss of function due to fibrosis) could be prevented in all patients. Statistical analyses between affected and normal hands showed significant differences. CONCLUSION:Posttraumatic dystrophy needs early detection for successful therapy and should not be identified under the umbrella term "complex regional pain syndrome" (CRPS).