ascorbic-acid and Reflex-Sympathetic-Dystrophy

The public health cost impact of complex regional pain syndrome type I (CRPS I) is considerable in both emergency and scheduled orthopaedic surgery. We proposed to assess the effectiveness of vitamin C in prevention of CRPS I in foot and ankle surgery.. We carried out a "before-after" quasi-experimental study comparing two chronologically successive groups without (Group I: July 2002-June 2003) and with (Group II: July 2003-June 2004) preventive 1g daily vitamin C treatment. All patients having surgery on the foot or ankle were enrolled, with the exception of diabetic foot cases. Several factors were analysed: sex, age, type of pathology, history of CRPS I, psychological context, tourniquet time, and cast immobilisation time.. 420 feet (392 patients) were included in the study: 185 in Group I, 235 in Group II. CRPS I occurred in 18 cases in Group I (9.6%) and 4 cases in Group II (1.7%) (p<10(-4)), with history of CRPS I as a significantly correlated factor (relative risk=10.4). The psychological context (anxio-depressive state) showed a (sub-significant) tendency to increase the risk of CRPS I (relative risk=2.6).. Vitamin C has been shown to be effective in preventing CRPS I secondary to wrist fracture, but few data are available with respect to foot and ankle cases. The present study demonstrates the effectiveness of vitamin C in preventing CRPS I of the foot and ankle-a frequent complication in our control group (9.6%). The authors recommend preventive management by vitamin C.

Topics: Adolescent; Adult; Aged; Ankle Injuries; Antioxidants; Ascorbic Acid; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Foot Injuries; Humans; Male; Middle Aged; Orthopedic Procedures; Pain, Postoperative; Prospective Studies; Reflex Sympathetic Dystrophy; Syndrome; Treatment Outcome; Young Adult

Complex regional pain syndrome type I is treated symptomatically. A protective effect of vitamin C (ascorbic acid) has been reported previously. A dose-response study was designed to evaluate its effect in patients with wrist fractures.. In a double-blind, prospective, multicenter trial, 416 patients with 427 wrist fractures were randomly allocated to treatment with placebo or treatment with 200, 500, or 1500 mg of vitamin C daily for fifty days. The effect of gender, age, fracture type, and cast-related complaints on the occurrence of complex regional pain syndrome was analyzed.. Three hundred and seventeen patients with 328 fractures were randomized to receive vitamin C, and ninety-nine patients with ninety-nine fractures were randomized to receive a placebo. The prevalence of complex regional pain syndrome was 2.4% (eight of 328) in the vitamin C group and 10.1% (ten of ninety-nine) in the placebo group (p=0.002); all of the affected patients were elderly women. Analysis of the different doses of vitamin C showed that the prevalence of complex regional pain syndrome was 4.2% (four of ninety-six) in the 200-mg group (relative risk, 0.41; 95% confidence interval, 0.13 to 1.27), 1.8% (two of 114) in the 500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.77), and 1.7% (two of 118) in the 1500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.75). Early cast-related complaints predicted the development of complex regional pain syndrome (relative risk, 5.35; 95% confidence interval, 2.13 to 13.42).. Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended.

Topics: Analysis of Variance; Antioxidants; Ascorbic Acid; Chi-Square Distribution; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fractures, Bone; Humans; Male; Middle Aged; Reflex Sympathetic Dystrophy; 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

Topics: Aged; Antioxidants; Ascorbic Acid; Diagnosis, Differential; Fracture Healing; Fractures, Bone; Humans; Incidence; Randomized Controlled Trials as Topic; Reflex Sympathetic Dystrophy; Wrist Injuries

The pathogenesis of reflex sympathetic dystrophy (RSD) is not clear, nor is there a definitive treatment for this syndrome. The morbidity, costs in health care, and loss of work time justify the search for a means to prevent post-traumatic dystrophy. Although the role of toxic oxygen radicals has not yet been clarified, we investigated vitamin C (ascorbic acid) as a prophylactic antioxidant drug.. 123 adults with 127 conservatively treated wrist fractures were randomly allocated in a double-blind trial to take a capsule of 500 mg vitamin C or placebo daily for 50 days. Each participant's sex, age, side of fracture, dominance, fracture type, dislocation, reduction, and complaints with the plaster cast were recorded, and they were clinically scored for RSD. The follow-up lasted 1 year.. Eight patients were withdrawn after randomisation. 52 patients with 54 fractures (male 22%, female 78%; mean age 57 years) received vitamin C and 63 patients with 65 fractures (male 20%, female 80%; mean age 60 years) received placebo. RSD occurred in four (7%) wrists in the vitamin C group and 14 (22%) in the placebo group 15% (95% CI for differences 2-26). Other significant prognostic variables for the occurrence of RSD were complaints while wearing the cast (relative risk 0.17 [0.07-0.41]) and fracture type (0.37 [0.16-0.89]).. This prospective, double-blind study shows that vitamin C was associated with a lower risk of RSD after wrist fractures. Our hypothesis is that this beneficial effect of prophylaxis would be useful in other forms of trauma.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Casts, Surgical; Female; Fracture Healing; Fractures, Bone; Humans; Male; Middle Aged; Reflex Sympathetic Dystrophy; Wrist Injuries

Topics: Ankle Injuries; Antioxidants; Ascorbic Acid; Female; Foot Injuries; Humans; Male; Orthopedic Procedures; Pain, Postoperative; Reflex Sympathetic Dystrophy

Topics: Ankle Injuries; Antioxidants; Ascorbic Acid; Female; Foot Injuries; Humans; Male; Orthopedic Procedures; Pain, Postoperative; Reflex Sympathetic Dystrophy

A 5 year old female developed features of complex regional pain syndrome (CRPS) i.e excessive pain to touch, decreased sweating and edema of left ankle 2 years after fracture of left tibia. Gum bleeding, petechiae and pseudoparalysis and suggestive radiograph characterized scurvy. Hyperesthesia improved and child walked with support following administration of vitamin C.

Topics: Ascorbic Acid; Child, Preschool; Female; Humans; Knee Joint; Radiography; Reflex Sympathetic Dystrophy; Scurvy; Vitamins

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

Topics: Animals; Ascorbic Acid; Fractures, Bone; Humans; Incidence; Rats; Reflex Sympathetic Dystrophy; Vitamins; Wrist Injuries

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Double-Blind Method; Female; Fractures, Bone; Free Radical Scavengers; Humans; Immobilization; Male; Middle Aged; Randomized Controlled Trials as Topic; Reflex Sympathetic Dystrophy; Reproducibility of Results; Treatment Outcome; Wrist Injuries

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Fractures, Bone; Humans; Middle Aged; Randomized Controlled Trials as Topic; Reflex Sympathetic Dystrophy; Wrist Injuries