Prevalence of Neuropathic Pain in Patients with Fracture of the Distal Extremity of the Radius Treated with Volar Locking Plate

Silva, Helbert Luiz Nomura da; Tanaka, Giuliana Olivi; Pinheiro, Thiago Barros; Abdouni, Yussef Ali

doi:10.1055/s-0041-1736526

Abstract

Objective

To evaluate the prevalence of persistent pain in the postoperative period of fractures of the distal extremity of the radius, as well as to detect early signs of neuropathic pain to develop protocols for the prevention of chronic postoperative pain.

Methods

Prospective study, carried out with 56 patients who underwent open reduction and internal fixation of fractures of the distal extremity of the radius with a volar locking plate from March to September 2020. The patients were submitted to assessment of neuropathic pain and functional capacity through the Douleur Neuropathique 4 questionnaire (DN4) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaires. Qualitative variables were compared using the Mann-Whitney U test and their correlation was analyzed using the Spearman Correlation and Equality of Two Proportions tests.

Results

A total of 43 patients aged between 18 and 66 years old were included in the present study; 39.5% of the participants scored ≥ 4 on the DN4 questionnaire. In relation to Quick-DASH, the average was 38.6. There was no statistically significant difference between the gender of the patient and the DN4 value (p= 0.921). There was also no statistical correlation between the quantitative variables DN4 and Quick-DASH (p= 0.061).

Conclusions

The prevalence of neuropathic pain in analyzed postoperative patients was significant, and the presence of signs and symptoms of neuropathic pain was a positive predictive factor for pain persistence beyond 2 months in 100% of cases. Thus, with early diagnosis of the neuropathic component of pain, associated with the nociceptive component, adequate pain control can be achieved, preventing its chronicity, and ensuring better rehabilitation.

Keywords
radius fractures; pain measurement; postoperative complications; fracture fixation, internal

[1] Address for correspondence Giuliana Olivi Tanaka, MD, Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia “Pavilhão Fernandinho Simonsen”, Rua Doutor Cesário Mota Júnior, 112–Vila Buarque, 01221-020. São Paulo, SP, Brasil, olivitkg@gmail.com

	No difficulty	Mild difficulty	Moderate difficulty	Severe difficulty	Unable
1.Open a tight or new jar	1	2	3	4	5
2.Do heavy household chores (e.g. wash wall, floors)	1	2	3	4	5
3.Carry a shopping bag or briefcase	1	2	3	4	5
4.Wash your back	1	2	3	4	5
5.Use a knife to cut food	1	2	3	4	5
6.Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis, etc.)	1	2	3	4	5
	Not at all	Slightly	Moderately	Quite a bit	Extremely
7. During the past week, to what extent has your arm, shoulder, or hand problem interfered with your normal social activities with family, friends, neighbors or groups?	1	2	3	4	5
	Not limited at all	Slightly limited	Moderately limited	Very limited	Unable
8. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder, or hand problem?	1	2	3	4	5
Please rate the severity of the following symptoms in the last week. (circle number)	None	Mild	Moderate	Severe	Extreme
9. Arm, shoulder, or hand pain	1	2	3	4	5
10. Tingling (pins and needles) in your arm, shoulder or hand	1	2	3	4	5
	No difficulty	Mild difficulty	Moderate difficulty	Severe difficulty	So much difficulty that I can't sleep
11. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? (circle number)	1	2	3	4	5

	Mean	Median	Standard deviation	Minimum	Maximum	CI
Age	42.3	42	14.5	18	66	4.3
DN4	2.88	3	1.62	0	6	0.48
QuickDASH	38.6	35	18.4	15	80	55