Complex regional pain syndrome

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient presented with foot pain several weeks after an ankle fracture.

Patient Data

Age: 35
Gender: Female
X-ray

 

RIGHT LOWER LEG & ANKLE

 

Comparison is made with the previous examination from 28 August 2014. Tibial intremedullary nail in unchanged position. There is delayed union of the oblique fracture through the distal tibial diaphysis. Screw and plate fixation of distal fibular fracture unchanged. There is non-union of the spiral proximal right fibular fracture. The ankle joint alignment is normal. No new fracture identified.

 

Right foot

 

There is severe patchy osteopenia predominantly in periarticular distribution. No new fracture identified. The overall appearances are most in keeping with reflex sympathetic dystrophy (Sudeck atrophy).

X-ray

previous examination

Tibial intramedullary nail transfixes a comminuted tibial shaft fracture.

New posterior distal tibial plate and lateral malleolar plate and screws are noted.

Alignment at the mortise is within normal limits.

Minimally displaced proximal fibular fracture is unchanged in position.

 

X-ray

Previous study (postop)

 

There has been no change in alignment of the intramedullary nail fixating a comminuted tibial diaphyseal fracture. Oblique fracture of the proximal fibular shaft is similar to previous.

Comminuted distal fibular fracture involving the lateral malleolus, displaced posterior tibial plafond and minimally displaced medial malleolus fractures are similar to previous.

Case Discussion

Although there was no foot fracture, pain developed in the mid and forefoot. Radiographs demonstrate severe regional osteopenia with appearances mimicking focal lytic bone lesions, typically in the periarticular regions.

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Case information

rID: 31560
Case created: 15th Oct 2014
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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