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Gender Difference in Cast Pressure and the Relationship with Complex Regional Pain Syndrome
Melissa S. Arief, MD, MHS; Mukund Patel, MD; Christian Zaino
SUNY Downstate Medical Center, Brooklyn, NY

Introduction: Complex regional pain syndrome (CRPS) is a devastating complication of distal radius fractures. CRPS has been linked to high cast pressures and is three times more common in women then in men. This study sought to demonstrate the difference in cast pressures between genders and to suggest that this difference in cast pressure may be an attributing factor to the higher incidence of CRPS in women.
Materials and Methods: This study recruited healthy volunteers to demonstrate the difference in cast pressures between males and females. Each volunteer had both right and left hands casted in short arm casts by a single researcher. Cast pressure measurements were taken using an Ad Instruments Pressure Transducer by incorporating a 50cc empty normal saline bag into the cast at the level of the metacarpals with the hand positioned in mid-flexion (neutral) and in extension with increasing amount of air inserted into the empty saline bag to mimic increasing swelling.
Results: 25 volunteers were recruited for a total of 50 hands casted. 13 were male and 12 were female. The age range of the volunteers was from 18-72 years. Figure 1 demonstrates the average results of cast pressures for each gender with increasing amounts of "swelling". The results become statistically significant after 20 ml of air in the cast and the difference becomes increasingly accentuated as "swelling" continued to increase.
Conclusions: The results of this study demonstrated that females have statistically significant higher cast pressures than males after a small amount of "swelling" has been introduced into the cast and that this difference continues to increase as "swelling" is increased. The reason for this difference in cast pressure at this time is unclear but is possibly a result of the difference in the amount of soft tissue present on the hands between genders and further studies are indicated. The results of this study demonstrates a potentially very important factor in determining why females have a higher rate of CRPS than males as high cast pressures have been linked to the CRPS. This suggests that females with distal radius fractures who are placed in short arm casts should be monitored more closely then males for "tight" casts to potentially prevent the development of CRPS. Figure 1: This chart demonstrates the difference in average cast pressure between males and females as the amount of air in the normal saline bag is increased to simulate swelling.


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