Effect of Vitamin C on Frequency of Reflex Sympathetic Dystrophy in Wrist Fractures: A Randomised Trial

Author: Charlotte S Kelly / Editor: Stephen D Haig / Reviewer: Michael Stewart / Codes: SLO1, SLO10, TP7 / Published: 15/10/2018

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Description:

• Prospective, randomised, placebo controlled, double blinded trial
• Adults with wrist fractures attending a Dutch ED, treated conservatively
• Intervention – vitamin C 500mg once a day orally for 50 days
• Comparator – placebo
• Outcome – Presence or absence of RSD at 1 year (4 out of 6 symptoms throughout an area larger than the wrist – unexplained diffuse pain, difference in skin temperature or colour, diffuse oedema, limited active movement, and occurrence of these symptoms after activity).
• Assessed at 1/52, 4-5/52, 6-7/52, 12/52, 26/52, and 1 year
• Complaints whilst cast was on were also recorded.
• 123 patients were included – 8 excluded from analysis. 63 had placebo, and 52 had vitamin C (analysed patients). No significant difference between the groups at recruitment.
• 4/52 in vitamin C group vs 14/63 placebo group got RSD(7% versus 22% – p=0.0429)
• Type of fracture was also significant in the development of RSD (type A 39% had RSD, types B+C – 61% had RSD p=0.0002). Complaints in cast was also associated with development of RSD (p=0.0037)
• Conclusion – vitamin C may reduce the incidence of RSD in those with fractured wrists who are treated conservatively.