ascorbic-acid and Radius-Fractures

Complex regional pain syndrome type I (CRPS-I), previously known as reflex sympathetic dystrophy, is common after conservatively or surgically treated wrist fractures. Several studies support the efficacy of vitamin C in preventing CRPS-I, although the data are somewhat conflicting. The primary objective of this systematic literature review and meta-analysis was to assess the efficacy of vitamin C therapy in preventing CRPS-I after a wrist fracture.. Randomised, placebo-controlled trials of vitamin C to prevent CRPS-I after wrist fractures were sought in the three main databases: PubMed (1980 to December 2015), CENTRAL (Central 2015, number 12), and Embase (1980 to December 2015). Two authors worked independently to select articles. Data from selected articles were collected independently.. Three randomised placebo-controlled trials in a total of 875 patients were included. Treatment was non-operative in 758/890 (85.1%) fractures and operative in 132 (14.9%) fractures. Vitamin C supplementation was started on the day of the injury and continued for 50 days. In the group given 500mg of vitamin C daily, the risk ratio for CRPS-I was 0.54 (95%CI, 0.33-0.91; P=0.02). Thus, the risk of developing CRPS-I was significantly decreased by prophylactic treatment with 500mg of vitamin C per day. The heterogeneity rate was 65% (non-significant).. Daily supplementation with 500mg of vitamin C per day for 50 days decreases the 1-year risk of CRPS-I after wrist fracture.. II, systematic review of level I and II studies.

Topics: Antioxidants; Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Radius Fractures; Randomized Controlled Trials as Topic; Ulna Fractures; Wrist Injuries

Complex regional pain syndrome is a well-known complication after distal radius fracture with incidence ranging from 10.5 to 37 %. Some studies recommend the use of vitamin C to prevent complex regional pain syndrome. The objective of this meta-analysis was to evaluate the efficacy of vitamin C in prevention of CRPS.. We searched the PubMed, EMBASE and Cochrane library databases for randomized controlled trial (RCT) and comparative studies reporting use of vitamin C to prevent distal radius fracture. Dichotomous variable was presented as risk ratio with 95 % confidence intervals.. We obtained 220 articles from the database search. After the exclusion of duplicates, unrelated articles, letter to editor and editorials, we found four articles relevant to our topic. Meta-analysis of the CRPS incidence revealed that the incidence of CRPS was significantly lower in the vitamin C group [RD 0.41 (0.19-0.92), P = 0.03]. There was moderate to high heterogeneity in the studies included I (2) = 63 %).. Our analysis showed a significant reduction in prevalence of CRPS with the use of vitamin C. Further high-quality RCTs with standard dosages and common diagnostic criteria are needed to be able to deliver solid conclusions.

Topics: Analgesics; Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Middle Aged; Radius Fractures; Randomized Controlled Trials as Topic; Risk Factors

To determine whether vitamin C is effective in preventing complex regional pain syndrome (CRPS) in patients with distal radius fractures.. MEDLINE (1946 to present), EMBASE (1974 to present), and The Cochrane Library (no date limit) were systematically searched up to September 6, 2014, using MeSH and EMTREE headings with free text combinations.. Randomized trials comparing vitamin C against placebo were included. No exclusions were made during the selection of eligible trials on the basis of patient age, sex, fracture severity, or fracture treatment.. Two reviewers independently screened articles, extracted data, and applied the Cochrane Risk of Bias tool. Evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach.. Heterogeneity was quantified using the χ test and the I statistic. Outcome data were combined with a random effects model.. Across 3 trials (n = 890) of patients with distal radius fractures, vitamin C did not reduce the risk for CRPS (risk ratio = 0.45; 95% confidence interval, 0.18-1.13; I = 70%). This result was confirmed in sensitivity analyses to test the importance of missing data because of losses to follow-up under varying assumptions. Heterogeneity was explained by diagnostic criteria, but not regimen of vitamin C or fracture treatment.. The evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences.

Topics: Administration, Oral; Antioxidants; Ascorbic Acid; Causality; Comorbidity; Complex Regional Pain Syndromes; Evidence-Based Medicine; Female; Humans; Incidence; Male; Pain Measurement; Radius Fractures; Randomized Controlled Trials as Topic; Risk Factors; Sex Distribution; Treatment Outcome; Wrist Injuries

The American Academy of Orthopaedic Surgeons recommends the use of vitamin C to prevent complex regional pain syndrome (CRPS) for patients with distal radius fractures (DRFs). We hypothesized that the evidence for supporting this recommendation is weak, based on epidemiological principles of association and causality. The specific aim of this project was to test the validity of this recommendation.. We conducted a literature review to retrieve articles reporting on the use of vitamin C to prevent CRPS. Data collected included sample size, study design type, dose of vitamin C used, and outcome measures of association expressed as relative risk (RR) and odds ratio. We then applied Hill criteria to evaluate the relationship between vitamin C and CRPS.. We obtained 225 articles from the database search. After the exclusion of duplicates, unrelated articles, editorial letters, and commentaries, we found 4 articles and 1 systematic review relevant to our topic. Six of the 9 Hill criteria were met, and an earlier meta-analysis showed a quantified reduction in CRPS risk. However, criteria like biological plausibility, specificity, and coherence were not met.. The number of causal/association criteria met was adequate to support the scientific premise of the effect of vitamin C in preventing CRPS after DRF. Furthermore, vitamin C administration is of relatively low cost and has few complications unless administered in large doses. Owing to sufficient epidemiological evidence availability, the American Academy of Orthopaedic Surgeons recommendation of vitamin C to prevent CRPS has practical merit.. Therapeutic II.

Topics: Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Radius Fractures; Reproducibility of Results; Vitamins

Systemic vitamin C supplementation after wrist fracture has been suggested to reduce the incidence of complex regional pain syndrome (CRPS). This study aimed to evaluate the effect of regional vitamin C in Bier block in the early phase of fracture on CRPS occurrence following surgery for distal radius fractures.. Seventy-four patients with isolated extra-articular distal radius fracture with the plan of fixation under Bier block were enrolled. Patients were assigned randomly into two groups: receiving either 500 mg vitamin C or sterile water as a Bier block adjuvant. Both groups received 500 mg of oral vitamin C for six weeks. The patients were evaluated for CRPS signs and symptoms at 2, 4, 6, and 12 weeks post-surgery.. The overall incidence of CRPS 12 weeks after surgery in the vitamin C group was significantly less than the controls (22.9% vs 45.5%, p = 0.04). Logistic regression analysis showed that the only significant contribution in predicting the incidence of CRPS came from the intervention variable (OR 0.26, CI95% 0.08-0.85; P = 0.027).. The findings suggest that adding vitamin C 500 mg to the local anesthetic in Bier block significantly reduces the incidence of CRPS following distal radius fractures.

Topics: Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Incidence; Radius Fractures; Risk Factors

It is proposed that vitamin C administration can reduce disproportionate pain and stiffness after distal radius fracture; however, randomized trials that tested this hypothesis have had inconsistent results.. (1) Is administering vitamin C after distal radius fracture associated with better ROM, patient-reported upper extremity function, and pain scores? (2) What factors are associated with post-fracture finger stiffness and worse upper extremity function?. This is a double-blind, randomized, placebo-controlled, noncrossover study. Between August 2014 and July 2017, we approached 204 consecutive patients, of which 195 were eligible, and 134 chose to participate. Participants were randomized to receive once-daily 500 mg vitamin C (67 participants) or placebo (67 participants) within 2 weeks after distal radius fracture. All patients received usual care at the discretion of their surgeon. The mean age of participants was 49 ± 17 years, 99 patients (74%) were women, and 83 (62%) were treated nonoperatively. The primary outcome was the distance between the fingertip and distal palmar crease 6 weeks after fracture. This measure is easy to obtain and previously has been shown to correlate with aggregate ROM of all finger joints. The secondary outcomes were total active finger motion, total active thumb motion, upper extremity-specific limitations, and pain intensity.An a priori power analysis suggested 126 patients would provide 80% power to detect a difference of 2 cm (SD 4.0) fingertip distance to palmar crease with α set at 0.05 using a two-tailed Student's t-test. Accounting for 5% lost to followup, we included 134 patients.All analyses were intention-to-treat. Ten participants of the intervention group and five of the placebo group were lost to followup. Their missing data were addressed by multiple imputation, after which we performed linear regression analysis for our outcome variables.. Administration of vitamin C was not associated with ROM, function, or pain scores at 6 weeks (distance to palmar crease: β -0.23; 95% CI -1.7 to 1.2; p = 0.754; finger ROM: β 4.9; 95% CI, -40 to 50; p = 0.829; thumb ROM: β 0.98; 95% CI, -18 to 20; p = 0.918, Patient-Reported Outcomes Measurement Information System [PROMIS] score: β 0.32; 95% CI, -2.6 to 3.2; p = 0.828; pain score: β -0.62; 95% CI, -0.62 to 0.89; p = 0.729) nor at 6 months (PROMIS score: β -0.21; 95% CI, -3.7 to 3.3; p = 0.904; pain score: β 0.31; 95% CI, -0.74 to 1.4; p = 0.559). At 6 weeks, we found that more finger stiffness was mildly associated with greater age (β -1.5; 95% CI, -2.8 to -0.083; p = 0.038). Thumb stiffness was mildly associated with greater age (β -0.72; 95% CI, -1.3 to -0.18; p = 0.009) and strongly associated with operative treatment (β -32; 95% CI, -50 to -13; p = 0.001). Greater pain interference was modestly associated with greater functional limitations at 6 weeks (β -0.32; 95% CI, -0.52 to -0.12; p = 0.002) and 6 months (β -0.36; 95% CI, -0.60 to -0.11; p = 0.004).. Vitamin C does not seem to facilitate recovery after distal radius fracture, but amelioration of maladaptation to nociception (pain interference) merits greater attention.. Level I, therapeutic study.

Topics: Adult; Aged; Ascorbic Acid; Double-Blind Method; Female; Finger Joint; Humans; Joint Diseases; Male; Middle Aged; Prospective Studies; Radius Fractures; Range of Motion, Articular; Treatment Outcome; Vitamins

Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture.. A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score.. There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing.. This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius.. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Topics: Adult; Ascorbic Acid; Casts, Surgical; Chi-Square Distribution; Disability Evaluation; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Logistic Models; Male; Middle Aged; Pilot Projects; Postoperative Care; Prospective Studies; Radius Fractures; Range of Motion, Articular; Recovery of Function; Statistics, Nonparametric; Treatment Outcome; Wrist Injuries

Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Bone Nails; Female; Fracture Fixation; Humans; Male; Middle Aged; Radius Fractures; Reflex Sympathetic Dystrophy

The current recommendation is to use daily doses of vitamin C to prevent the occurrence of the complex regional pain syndrome (CRPS) following a distal radius fracture. The study is a synthesis of the four primary studies that examine this issue. These studies have been previously examined in the meta-analysis literature. The incidence of CRPS is lower in patients treated with the vitamin C protocol compared with the control. The significance of the difference varies from

Topics: Ascorbic Acid; Cohort Studies; Complex Regional Pain Syndromes; Humans; Incidence; Meta-Analysis as Topic; Radius Fractures; Risk Factors

Topics: Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Radius Fractures; Vitamins

Topics: Ascorbic Acid; Complex Regional Pain Syndromes; Humans; Radius Fractures; Vitamins

Topics: Administration, Oral; Ascorbic Acid; Humans; Radius Fractures; Reflex Sympathetic Dystrophy; Vitamins

To investigate the effects of free oxygen radicals and various antioxidants on bone healing after experimental formation of fracture.. Fifty male rats were used and divided into five groups (ten rats in each). The right forelimbs of the rats were broken by bimanual compression method. One hour before this procedure, 5 ml/kg of intraperitoneal (i.p.) physiologic saline were given to the control Group 1. All 40 rats in the experimental Groups 2, 3, 4 and 5 were treated with i.p. zymosan at a dosage of 100 mg/kg to induce the production of free radicals by stimulating NADPH oxidase in polymorphonuclear leukocytes. Zymosan induction was stopped on the fifth post-fracture day. In addition to the zymosan, i.p. 1 g/kg/day of dimethyl sulfoxide were given to the animals in Group 3, 50 mg/kg/d of Ginko biloba Extract (EGb 761) in Group 4 and 500 mg/kg/day of vitamin C in Group 5. Radiographs of the fractures of all animals were obtained to assess callus formation, remodeling and bridging bone formation under ether anesthetics on postfracture day 7, 14 and 21. All rats were euthanized on day 22, and sections of the radius and ulna were examined both histologically with light and electron microscopy and ultrastructurally. Statistical analysis was made with Kruskal-Wallis variance analyze test and comparison between groups was performed by Dunn's multiple comparison test.. An impairment of bone healing was observed in Group 2 inducted with purely zymosan. Variable results were obtained for bone healing in the groups treated with various antioxidants. There was very significant difference of fracture healing between Groups 1 and 2 both histologically and radiologically (P < 0.001). There was significant difference between Groups 2 and 5 radiologically (P < 0.05).. Free oxygen radicals demonstrate a negative effect on fracture healing and vitamin C (an antioxidant) partially prevents the negative effect of zymosan on fracture healing.

Topics: Animals; Antioxidants; Ascorbic Acid; Dimethyl Sulfoxide; Disease Models, Animal; Fracture Healing; Free Radical Scavengers; Free Radicals; Ginkgo biloba; Male; Plant Extracts; Radius Fractures; Random Allocation; Rats; Rats, Wistar; Research Design; Statistics, Nonparametric; Time Factors; Ulna Fractures; Zymosan

Topics: Anabolic Agents; Animals; Ascorbic Acid; Calcium; Cissus; Collagen; Dogs; Fracture Healing; Fractures, Bone; Glycosaminoglycans; Plants, Medicinal; Radius Fractures; Rats; Research; Steroids; Ulna; Wound Healing