[Prevention of algodystrophy of the upper limb].

Treatment of algodystrophy is a challenge. Early recognition and immediate commencement of effective therapy gives a real chance of recovery, whereas progression into chronic phase is associated with poor prognosis and disability of the limb. Prevention of the condition is a reasonable approach, but little is known about it. Some authors have claimed that careful operative technique, anatomic dissection, avoidance of nerve traction, proper postoperative care and early mobilization of the limb after trauma or operation can reduce risk the frequency of algodystrophy, but this has not been scientifically confirmed. This paper presents current knowledge about prophylaxis of algodystrophy, based on literature and author's own experience. It was stated that, as yet, no specific, effective measures are known to prevent algodystrophy. Administration of 0.5 g vitamin C for 50 days after fracture of the distal radius reduces risk of the condition, but is was reported in only one study. Operation of unstable distal radial fractures, avoiding of tight, uncomfortable plaster casts and painful, forced physiotherapy is believed to reduce risk of algodystrophy, but it is based on observation rather than scientific evidence. Patients who recovered form algodystrophy are not more susceptible to recurrence after further trauma or surgery. An early recognition of incipient algodystrophy and immediate commencement of effective therapy (i.e., with Mannitol and Dexamethasone) was found to be the most important part of prophylaxis of the development of the florid condition.