Presentation
History of a left fibular fracture that occurred one month ago. The patient presented with left leg pain, swelling, redness, and tenderness to touch.
Patient Data
Left-sided oblique mildly displaced fracture of the distal fibula with a thin single layer of periosteal reaction adjacent to it, without surrounding callus formation.
There is soft tissue swelling around the left ankle, along with osteopenia and cortical thinning of the distal tibia, fibula, and visualised tarsal bones.
Case Discussion
Sudeck’s atrophy, also known as complex regional pain syndrome, is clinically characterised by pain and hyperalgesia or allodynia that is not confined to a specific dermatome or myotome and is usually disproportionate to the inciting event, which is mostly traumatic.
Soft tissue swelling, skin hyperaemia, and patchy osteopenia are also commonly encountered.
This patient, with a history of distal fibular fracture (that is delayed in healing/union), has severe subperiosteal bone resorption and profound osteopenia mainly periarticular.
The presence of the fracture may indicate disuse osteopenia, which may be present as a contributing factor for bone loss, but the clinical presentation of our patient along with marked soft tissue involvement makes CRPS a more suitable diagnosis.
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