Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes.

INTRODUCTION: Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS: Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION: Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. INTRODUCTION: The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. METHODS: This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. RESULTS: The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). CONCLUSION: After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.

Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review.

INTRODUCTION: The objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritis (PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients. MATERIALS AND METHODS: Nineteen studies were included (10 open source data). RESULTS: In total, 733 patients were described with a weighted mean age of 37 years (range 25-54) at the time of the injury. Follow-up ranged from 13 months to 38 years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (N = 49, mean 14°, SD 6° versus N = 55, mean 17°, SD 6°, p = 0.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA. CONCLUSIONS: A high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture. LEVEL OF EVIDENCE: Level of evidence 3 (Phillips et al. Levels of Evidence-Oxford Centre for Evidence-based Medicine, 1).

Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment.

INTRODUCTION: This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course. METHODS: We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course. RESULTS: The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001). CONCLUSIONS: After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.

The Dutch nationwide trauma registry: The value of capturing all acute trauma admissions.

INTRODUCTION: Twenty years ago the Dutch trauma care system was reformed by the designating 11 level one Regional trauma centres (RTCs) to organise trauma care. The RTCs set up the Dutch National Trauma Registry (DNTR) to evaluate epidemiology, patient distribution, resource use and quality of care. In this study we describe the DNTR, the incidence and main characteristics of Dutch acutely admitted trauma patients, and evaluate the value of including all acute trauma admissions compared to more stringent criteria applied by the national trauma registries of the United Kingdom and Germany. METHODS: The DNTR includes all injured patients treated at the ED within 48 hours after trauma and consecutively followed by direct admission, transfers to another hospital or death at the ED. DNTR data on admission years 2007-2018 were extracted to describe the maturation of the registry. Data from 2018 was used to describe the incidence rate and patient characteristics. Inclusion criteria of the Trauma Audit and Research (TARN) and the Deutsche Gesellschaft für Unfallchirurgie (DGU) were applied on 2018 DNTR data. RESULTS: Since its start in 2007 a total of 865,460 trauma cases have been registered in the DNTR. Hospital participation increased from 64% to 98%. In 2018, a total of 77,529 patients were included, the median age was 64 years, 50% males. Severely injured patients with an ISS≥16, accounted for 6% of all admissions, of which 70% was treated at designated RTCs. Patients with an ISS≤ 15were treated at non-RTCs in 80% of cases. Application of DGU or TARN inclusion criteria, resulted in inclusion of respectively 5% and 32% of the DNTR patients. Particularly children, elderly and patients admitted at non-RTCs are left out. Moreover, 50% of ISS≥16 and 68% of the fatal cases did not meet DGU inclusion criteria CONCLUSION: The DNTR has evolved into a comprehensive well-structured nationwide population-based trauma register. With 80,000 inclusions annually, the DNTR has become one of the largest trauma databases in Europe The registries strength lies in the broad inclusion criteria which enables studies on the burden of injury and the quality and efficiency of the entire trauma care system, encompassing all trauma-receiving hospitals.

Nonoperatively treated type A spinal fractures: mid-term versus long-term functional outcome.

This study focuses on the mid-term (four years) and long-term (ten years) functional outcome of patients treated nonoperatively for a type A spinal fracture without primary neurological deficit. Functional outcome was measured using the visual analogue scale spine score (VAS) and the Roland-Morris disability questionnaire (RMDQ). The 50 patients included were on average 41.2 years old at the time of injury. Four years post injury, a mean VAS score of 74.5 and a mean RMDQ score of 4.9 were found. Ten years after the accident, the mean VAS and RMDQ scores were 72.6 and 4.7, respectively (NS). No significant relationships were found between the difference scores of the VAS and RMDQ compared with age, gender, fracture sub-classification, and time between measurements. Three (6%) patients had a poor long-term outcome. None of the patients required surgery for late onset pain or progressive neurological deficit. Functional outcome after a nonoperatively treated type A spinal fracture is good, both four and ten years post injury. For the group as a whole, four years after the fracture a steady state exists in functional outcome, which does not change for ten years at least after the fracture.

Follow-up for osteoporosis in older patients three years after a fracture.

BACKGROUND: Recently a Fracture and Osteoporosis outpatient clinic (FO clinic) was set up at the University Medical Centre groningen (UMCG) with the aim to optimise case-finding of osteoporosis in older patients with a low-energy fracture. To provide a diagnostic setting before the start of our fo clinic, case-finding was carried out in patients who suffered an 'osteoporotic' fracture in the year prior to the foundation of the FO clinic. During a three years follow up project, osteoporotic patients who needed therapy were identified. METHODS: Patients aged 50 years or older who were seen in the UMCG for a low-energy fracture (shoulder, wrist or hip) one year before that period were asked to participate. The study was carried out in two parts - a telephone questionnaire and measurement of the bone mineral density (BMD). The data were compared with the results of the FO clinic. RESULTS: Of the 191 patients, 88 could be contacted and were analysed. of these 88 patients only 12 had undergone additional investigations for the presence of osteoporosis in the year of the fracture, and only six patients were on antiosteoporosis medication; 45 patients had already suffered an earlier fracture and ten had a more recent subsequent fracture. Measurements three years after their fracture revealed that 55% of the 88 patients had osteoporosis (T-score less than -2.5 SD). CONCLUSION: After a fracture, case-finding for osteoporosis is good clinical practice. In our study more than half of the patients were lost for follow-up after three years. But it is still worthwhile to check whether patients with fractures in the past had the necessary diagnostics and proper therapy. Comparing these results with those of the FO clinic, it is evident, however, that case-finding of osteoporosis after a fracture can be organised most effectively at the location where the patient first attends for treatment of the fracture, namely in the emergency department of the hospital.

Return to work and quality of life in severely injured patients.

BACKGROUND: Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life. METHODS: In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS > or = 16, mean ISS 24, range 16 - 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement. RESULTS: Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. "No disability" (SIP score < or = 3) was found in 55% of the patients, whereas 11% of the patients reported "severe disability" (SIP score > or = 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement. CONCLUSIONS: Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.

An automatic autotransfusion system with a centrifugal pump: a hematologic evaluation in dogs.

The requirements that have to be met by an on-line autotransfusion system (ATS) in case of massive blood loss are a sufficient capacity for reinfusing the shed blood, an optimal hemocompatibility, ability to prevent reinfusion of aspirated air, and ease of operation. In a previous study we tested a diaphragm pump in our pneumatically driven ATS that met these requirements. In this study a centrifugal pump was used as an outflow pump in otherwise the same system. A centrifugal pump has important advantages: It prevents the occurrence of massive air embolism, accidental obstruction of the outflow line will not cause bursting of the tubing, and there is no spallation. There are also indications that a centrifugal pump causes less stimulation of the coagulation cascade than do other pumps. Because of these advantages, we were interested in the hemocompatibility and pumping characteristics of the centrifugal pump in our ATS. From this study we conclude that the hemocompatibility of the centrifugal pump was not significantly different from that of the previously tested diaphragm pump. Also, the system can easily and safely be operated by non-specialized personnel. Because of the advantages, especially in pumping characteristics, the centrifugal pump is our choice in on-line ATSs.

An automatic pneumatically driven autotransfusion system: a hematologic evaluation in dogs.

An automatic, pneumatically driven autotransfusion system (ATS) was developed because ATSs driven by roller pumps are complicated to set up and require an experienced operator. In this ATS blood is aspirated into a cardiotomy reservoir by means of a constant vacuum applied on that reservoir. Damage to blood cells is reduced by an electronic device that regulates an automatic tubing clamp in the suction line to prevent suction of air along with blood (controlled suction). The blood is reinfused by a diaphragm pump driven by alternating vacuum and compressed air. The frequency of this pump is regulated by a level sensor in the cardiotomy reservoir to maintain a constant preset level. When we tested this automatic ATS in dogs, platelet function and platelet numbers substantially recovered after a dip during an autotransfusion period of 1 hour. Advantages of this ATS are that it causes only minor blood damage, it does not require a specially trained operator, and it is ready to use in every operating room. The diaphragm pump can be made disposable and integrated in the bottom of a cardiotomy reservoir.

Interleukin-6 and its relation to the humoral immune response and clinical parameters in burned patients.

The cytokine interleukin-6, which has been shown to be increased in patients with burn injuries, is produced by activated monocytes and endothelial cells and has many in vitro activities, including stimulation of acute-phase protein synthesis in hepatocytes, immunoglobulin synthesis in B lymphocytes, and stimulation of growth of megakaryocytes. In 13 patients with a mean of 31% full-thickness burns, we studied the relation of serum interleukin-6 to clinical parameters and parameters of the acute-phase response and immunoglobulin production. Interleukin-6 was already elevated within hours after the injury was sustained, and it remained elevated for several weeks. All components of the acute-phase response were observed: fever, tachycardia, leukocytosis with an associated left shift, elevation of C-reactive protein and alpha 1-antitrypsin, and a decrease in albumin levels. In the second week after burn injury, immunoglobulin M levels peaked, followed by a prolonged elevation of immunoglobulin G levels. Thrombocyte counts initially decreased and rebounded to supranormal levels after 2 weeks. Interleukin-6 levels were positively correlated with acute-phase responses. We believe that the production of interleukin-6 induces the synthesis of acute-phase proteins. High interleukin-6 levels may also be an etiologic factor in the marked immunoglobulin response observed. Likewise, the relation between the megakaryocyte-promoting activity of interleukin-6 and the rebound thrombocytosis requires further investigation.

Erectile dysfunction due to a 'hidden' penis after pelvic trauma.

We describe a twenty-six year old patient who presented us with a dorsally retracted 'hidden' penis, which was entrapped in scar tissue and prevesical fat, 20y after a pelvic fracture with symphysiolysis. Penile 'lengthening' was performed by V-Y plasty, removal of fatty tissue, dissection of the entrapped corpora cavernosa followed by ventral fixation.

Troponin I, troponin T, CKMB-activity and CKMB-mass as markers for the detection of myocardial contusion in patients who experienced blunt trauma.

Myocardial contusion is an infrequent, but sometimes serious complication in patients who experienced deceleration (blunt) trauma. We investigated the assessment of the new cardiac markers troponin I (cTnI) and troponin T (cTnT) in relation to the conventional CKMB-activity, the CKMB-activity/CK-total ratio, CKMB-mass and the CKMB-mass/CK-total ratio for the detection of myocardial contusion in 89 patients with blunt trauma (38 patients with thoracic injuries and 51 patients without thoracic injuries). All parameters were analysed at admission (t1) and 24 h after admission (t2). For the patients with thoracic injuries, at t1 cTnI was elevated in three, and cTnT in four patients; at t2 both cTnI and cTnT were elevated in nine patients. At t1, eighteen to thirty patients had increased levels of the conventional parameters; at t2 this was true for six to thirty-five patients. For the patients without thoracic injuries all cTnI and cTnT levels were within the reference ranges at t1. At t2 one patient, who experienced an acute myocardial infarction, had elevated cTnI and cTnT levels. At t1, five to thirty-five patients had increased levels of the conventional parameters; at t2 this was true for four to forty-two patients. From this study we conclude that the conventional parameters are not useful for the detection of myocardial contusion in patients experiencing blunt trauma. The parameters cTnI and cTnT are equally accurate and more reliable for the selection of patients who require intensive cardiac monitoring. If at admission the cTnI or the cTnT levels are within the reference ranges, a second analysis after admission is necessary to reach a reliable conclusion concerning myocardial contusion as a result of trauma on basis of the troponin levels.

Tumor necrosis factor alpha (TNFalpha) in human skin: a comparison of different antibodies for immunohistochemistry.

Conflicting results have been reported regarding the localization and presence of TNFalpha in normal human skin. To study TNFalpha expression, we tested a panel of antibodies directed against human TNFalpha. First, antibodies were tested for immunoreactivity on cytospots of isolated LPS-stimulated peripheral blood mononuclear cells. Second, antibodies were tested to detect recombinant TNFalpha in Western blots. Some antibodies were found to be unable to detect recombinant TNFalpha in the blots. However, most antibodies were able to bind TNFalpha protein, but they did not bind to other irrelevant proteins that were also present in the blots. Finally, antibodies were tested on cryosections of normal human skin. Antibodies that did not react with TNFalpha in the blots were incubated with TNFalpha before the staining procedure to see whether these antibodies specifically bound TNFalpha. We found that, although all the antibodies bound TNFalpha, there were clear differences in staining patterns. This indicates that these antibodies may recognize distinct epitopes or different forms of TNFalpha. The differences found in this study and those reported previously could be the result of differences in the concentration of antibody used, the staining procedure or specificity of the antibody itself. So, for unambiguous interpretation of data, it is important to know the characteristics of the antibodies used.

Traumatic hemipelvectomy.

Traumatic hemipelvectomy is rare, and is usually accompanied by injury to the genito-urinary tract and bowel. Recently, there have been an increasing number of reports of patients who have survived this injury, probably as a result of improved early care. We report three such cases and review the literature. The amputation wound should not be closed initially; early re-exploration to remove any dead tissue is indicated, and this should be repeated as necessary.

Local cellular inflammation as a result of elective standardized vascular surgery.

During surgery, incision of the skin under aseptic conditions is performed. Despite the absence of noxious agents, an inflammatory response may be induced. We studied the local inflammatory response in human skin as a result of surgical intervention, under aseptic conditions. Elective standardized vascular surgery served as a model. A series of skin biopsies was taken from the wound edge at different time points after first incision. Biopsies, directly taken at first incision were considered to represent normal skin. Additional biopsies were taken at 30 min after the start of surgery and just before closure of the wound, maximally 270 min after surgery. Kinetics of recruitment of cells, expression of adhesion molecules and the presence of pro-inflammatory cytokines was studied. Granulocytes were observed at first at 30 min after incision of the skin and their number increased in time. This granulocyte infiltration is paralleled by E-selectin expression on endothelial cells, which also was observed at first at 30 min after surgery with a further increase in number in time. Incision of the skin did not change P-selectin, ICAM-1, VCAM-1, TNFalpha, IL1alpha, IL1beta, IL6 and IL8 expression. These results show that incision of the skin under aseptic conditions during elective standardized vascular surgery induces local nonspecific cellular inflammation.

Perfusion of burn wounds assessed by laser doppler imaging is related to burn depth and healing time.

Average perfusion in various burn wounds was assessed using Laser Doppler Imaging (LDI). The time necessary for a complete healing of the wound was compared to the results of the LDI measurements. A certain depth of burn was associated with a typical pattern of perfusion in the course of time. There was a significant difference between average perfusion in a full thickness burn requiring surgical treatment and burns with regenerative capacities.

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part I. Impairments and perceived disability.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part II. Social life events, general health and changes in occupation.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.