What is the cause of persistent pain in a 52-year-old female (F) with a history of right wrist fracture, sustained in August 2024?

From the Guidelines

For a 52-year-old female with ongoing pain from a right wrist fracture that occurred in August 2024, I strongly recommend radiographs to evaluate for nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis, as suggested by the most recent guidelines 1.

Key Considerations

• Persistent pain several months after a fracture suggests potential complications that need to be addressed to prevent long-term morbidity and mortality.
• The patient should be evaluated for possible causes of chronic pain, including nonunion, malunion, osteonecrosis, or post-traumatic osteoarthritis, as these conditions can significantly impact quality of life.
• Imaging studies, starting with radiographs, are crucial for diagnosing these complications, as they provide valuable information on the fracture's healing process and any potential issues that may be causing the pain 1.

Management Strategies

• In the meantime, pain management can include acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6 hours with food, not exceeding maximum daily doses (4000mg for acetaminophen, 3200mg for ibuprofen).
• Applying ice for 15-20 minutes several times daily can help reduce inflammation.
• Wearing a supportive wrist brace during activities, while removing it periodically to prevent stiffness, can also be beneficial.
• Gentle range-of-motion exercises like wrist circles and finger movements can help maintain mobility, but activities that cause sharp pain should be avoided.

Further Evaluation and Treatment

• If pain is severe or worsening, earlier medical evaluation is warranted to rule out complex regional pain syndrome or other complications.
• Physical therapy might be beneficial to restore strength and function.
• The patient should be closely monitored, and further imaging or specialist referral should be considered based on the clinical evaluation and response to initial management, as suggested by recent guidelines 1.

From the Research

Wrist Fracture and Persistent Pain

• A 52-year-old female who fractured her right wrist in August 2024 and still experiences pain may be concerned about the prolonged recovery time 2.
• Studies have shown that many individuals report persistent pain and functional limitations up to 18 months following a wrist fracture 2.
• The effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking 2.

Diagnostic Tools for Wrist Fractures

• SPECT/CT systems have been shown to be effective in detecting occult carpal fractures, especially when clinical signs strongly suggest a fracture 3.
• CT scans of the wrist can help evaluate posttraumatic injuries, particularly bony trauma, and provide improved contrast resolution and multiplanar imaging 4.
• Hounsfield unit measurements at the wrist can correlate with bone mineral density measurements of the hip, femoral neck, and lumbar spine, and may be used to detect osteoporosis 5.

Prognostic Models for Persistent Pain

• A prognostic model has been developed and validated to predict persistent pain 4 months after a wrist or hand fracture, using patient age and pain intensity reported at initial presentation as prognostic factors 6.
• The model has been shown to have moderate accuracy, with an area under the receiver operating characteristic curve of 0.63 in the development sample and 0.61 in the validation sample 6.