Early Recognition and Management of Complex Regional Pain Syndrome Following Distal Radius Fracture: A Structured Narrative Review.

Complex regional pain syndrome (CRPS) is a chronic pain disorder that may develop following a distal radius fracture and can result in significant functional impairment and prolonged disability. Early diagnosis remains challenging because symptoms frequently overlap with normal post-fracture recovery. This structured narrative review evaluated current evidence regarding the timing of diagnosis, early predictors, and early management strategies influencing outcomes of CRPS following distal radius fracture. A structured literature search of PubMed/MEDLINE and Embase was performed for English-language studies published between 2000 and 2026 using combinations of keywords related to CRPS, distal radius fracture, diagnosis, risk factors, prevention, and management. Studies involving adult patients with CRPS following distal radius or wrist fracture and addressing diagnosis, predictors, or early management strategies were included. Owing to heterogeneity in study designs and outcome measures, findings were synthesized using thematic narrative analysis. Twenty-six studies met the inclusion criteria. Evidence suggests that clinical and physiological abnormalities associated with CRPS may emerge during the early post-injury period, although formal diagnosis is often established weeks to months after fracture treatment. Higher early pain intensity, enhanced pain sensitization, fibromyalgia, female sex, older age, lower vitamin D levels, and certain genetic polymorphisms were associated with an increased risk of CRPS. Early mobilization and structured rehabilitation strategies were associated with improved functional outcomes and lower reported CRPS incidence in several studies. Evidence regarding vitamin C prophylaxis was heterogeneous, with meta-analyses suggesting potential benefit while individual randomized controlled trials reported inconsistent findings. Imaging modalities demonstrated limited sensitivity for early diagnosis, reinforcing the importance of longitudinal clinical assessment. CRPS remains an uncommon but clinically important complication following a distal radius fracture. Current evidence supports the concept that altered recovery trajectories and early pain amplification may precede formal diagnosis. Careful monitoring of recovery, recognition of disproportionate symptoms, and promotion of early functional rehabilitation may facilitate earlier identification and management. Further prospective studies using standardized diagnostic criteria are required to better define early predictors and optimize preventive strategies.