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Posted by on Nov 21, 2018 in Bioethics, CRPS / RSD | 0 comments

Falls & fractures (21.11.2018)

Falls & fractures (21.11.2018)

An interesting statistic caught my eye today, in a report from the Canadian Institute for Health Information(1); or CIHI) for short. I received the report as part of the biomedical ethics (bioethics) side of my life, but what caught my eye was relevant to my patient life.

There’s often a significant crossover, between these 2 distinct parts of my life. The statistic of interest? It’s that:

“Unintentional falls remain the most common cause of hospitalizations and emergency department (ED) visits for injury and trauma”(2) in Canada.

This caught my attention because fractures are a known trigger for Complex Regional Pain Syndrome (CRPS), particularly Colles’ fractures like the one shown in my x-ray. That’s a specific type of fracture of the radius, proximal (close) to the wrist.

And the cause of my Colles’ fracture, which triggered CRPS, was… [drumroll please…] a fall. I slipped on a patch of ice in March 2016, during a Montréal winter. It had been a beautiful sunny day, so some of the snow on the surfaces of the roads had melted in the sunlight; when a weather system moved in during the evening hours, the temperature dropped significantly over just a few hours. All that recently thawed snow froze again, into slick patches of ice that were more or less invisible; what we call ‘black ice’ because it looks just like the black surfacing of our roadways.

But these types of icy falls, which can happen in most of Canada, also cause lower-body fractures. CRPS is triggered primarily by injuries (e.g. fractures, sprains, surgery, or other trauma) to the limbs; to an arm or a leg, a hand or a foot. This CIHI report, which they acknowledge likely under-reports this incidence, goes on to state that:

“According to our latest data, there were almost 654,000 reported ED visits for injuries sustained after unintentional falls, accounting for almost a third of all reported ED visits for injury and trauma last year”.(2)

That’s well over half a million potential cases of CRPS. This is important, because “CRPS/RSD is not well recognized in Canada”.(3) RSD, by the way, is the previous name for this disease; Reflex Sympathetic Dystrophy. According to the organization Promoting Awareness of RSD and CRPS in Canada (PARC):

“Even though some doctors are now diagnosing it sooner, many patients aren’t seen soon enough during the zero to six month window when there is an 80-90% success rate. Others are diagnosed and do not receive the proper treatment.
Why? In medical school, CRPS is not taught. By better educating the medical community on this rare disease, we hope that every newly diagnosed patient will be able to have successful treatment.”(3)

an x-ray of a broken arm (radius bone)

Photo & imaging: Sandra Woods

This lack of awareness is surprising, given that  CRPS “is widely considered to be the single worst source of pain – ranking higher on pain scales than childbirth, cancer and amputation… As a result, patients with CRPS… according to the National Institutes of Health – can search for an average of approximately four years before being properly diagnosed with the condition”.(4)

Photo & imaging: Sandra WoodsThis month is CRPS Awareness Month, so I took the opportunity to cross-post to the bioethics portion of this blog site – with a question. If there are – at a minimum – over a half million ED visits for falls in a year, a good proportion of those are likely to be for fractures and sprains. So why aren’t our physicians, and nurses, taught to look for signs & symptoms of CRPS at the follow-up visits of these patients?

In my case, the signs and symptoms of CRPS  presented within days of the fracture; but were then dismissed and/or disregarded by the hospital physician handling my follow-up care. It took almost 3 months for me to receive a diagnosis, despite requesting a 2nd opinion. And by that time the treatment window, for the best chance of disease resolution, had closed. So I try to increase awareness of this neuro-inflammatory and autoimmune disease, to prevent this from happening to other patients. People injured among those – at least – 654,000 ED visits for falls each year!

 

 

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(1) Canadian Institute for Health Information (CIHI). About us: “The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians… Web. Accessed 21 Nov 2018:
https://www.cihi.ca/en/about-cihi

(2) Canadian Institute for Health Information (CIHI). Exercise caution: Canadians frequently injured in falls. Web. Accessed 21 Nov 2018:
https://www.cihi.ca/en/exercise-caution-canadians-frequently-injured-in-falls

(3) Promoting Awareness of RSD and CRPS in Canada (PARC). Recognition of CRPS/RSD. Web. Accessed 21 Nov 2018:
https://www.rsdcanada.org/parc/english/parc/aboutus.html

(4) News-Medical.Net. CRPS rank higher on pain scales than childbirth, cancer, amputation. 25 Mar 2016. Web. Accessed 21 Nov 2018:
https://www.news-medical.net/news/20160325/CRPS-rank-higher-on-pain-scales-than-childbirth-cancer-amputation.aspx

 

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