A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA

Alice Lee; Richard Kwasnicki; Abigail Chan; Ben Smith; Alex Wickham; Shehan Hettiaratchy

doi:10.1302/1358-992X.2022.5.005

Article alerts Social media

Current issue

General Orthopaedics

A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA

The British Limb Reconstruction Society (BLRS) Annual Meeting 2022, Brighton, England, 24–25 March 2022.

Alice Lee
Richard Kwasnicki
Abigail Chan
Ben Smith
Alex Wickham
Shehan Hettiaratchy

A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA

Lee A, Kwasnicki R, Chan A, Smith B, Wickham A, Hettiaratchy S. A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA. Orthop Procs. 2022;104-B(SUPP_5):5-5. doi:10.1302/1358-992X.2022.5.005

Lee, Alice, et al. “A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_5, 2022, pp. 5-5., https://doi.org/10.1302/1358-992X.2022.5.005

Lee, A., Kwasnicki, R., Chan, A., Smith, B., Wickham, A., & Hettiaratchy, S. (2022). A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA. Orthopaedic Proceedings, 104-B(SUPP_5), 5-5. https://doi.org/10.1302/1358-992X.2022.5.005

Lee, A., Kwasnicki, R., Chan, A., Smith, B., Wickham, A. and Hettiaratchy, S. (2022) “A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA.” Orthopaedic Proceedings, 104-B(SUPP_5), pp. 5-5. Available at: https://doi.org/10.1302/1358-992X.2022.5.005

Lee, Alice, Richard Kwasnicki, Abigail Chan, Ben Smith, Alex Wickham, and Shehan Hettiaratchy. “A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA.” Orthopaedic Proceedings 104-B, no. SUPP_5 (2022): 5-5. https://doi.org/10.1302/1358-992X.2022.5.005

Lee A, Kwasnicki R, Chan A, Smith B, Wickham A, Hettiaratchy S. A MULTICENTRE OBSERVATIONAL PILOT STUDY OF NERVE DYSFUNCTION AND PAIN IN LOWER LIMB TRAUMA. Orthop Procs. 2022 Apr 1;104-B(SUPP_5):5-5. https://doi.org/10.1302/1358-992X.2022.5.005

Copy to clipboard

BibTeX

EndNote

RIS

Abstract

Introduction

Pain after trauma has received relatively little research attention compared with surgical techniques and functional outcomes, but is important to patients. We aimed to describe nerve dysfunction and pain characteristics using tibial fractures as a model. We hypothesized that early nerve dysfunction was associated with neuropathic and chronic pain.

Materials and Methods

Adult patients with isolated open or closed tibial diaphyseal fractures were prospectively observed for 1-year in 5 Major Trauma Centres. Nerve dysfunction was assessed using Semmes-Weinstein monofilaments, acute pain with the visual numerical rating scale (VNRS), neuropathic pain with the doleur neuropathique-4 score and quality of life (QOL) using the EQ-5D score.

Results

Of 77 included patients, twenty-six (33.8%) had Gustilo-Anderson grade II or worse injuries. Forty-six (63.0%) had operative repair; 0 operation notes reported nerve injury. Mean VNRS pain scores one week post-injury were 4.6/10 (SD 2.4). Seventeen patients (23.3%) presented with impaired sensation, persisting in 11 (15.1%) at 3-months. Neuropathic pain affected 16 (20.8%) patients one week post-injury; a further 20 (26.0%) had >2 symptoms of nerve pain. Only four (11.1%) received anti-neuropathic drugs. At 6-months, twenty-three (31.5%) reported mobility problems, 21 (28.8%) difficulty completing normal activities, 25 (34.2%) pain and 15 (20.5%) anxiety and depression.

Conclusions

Nerve dysfunction and neuropathic pain are common early features in patients with tibial fractures, but are poorly recognised and inadequately treated. Pain has long-term effects on patients’ QOL. Future work should aim to improve identification and management of neuropathic pain.