Vitamin C use for fractures: not a universal consensus
Vitamin C, or ascorbic acid, is a water-soluble organic compound that’s vital to a number of important bodily functions and also acts as a powerful antioxidant, but it isn’t made by the body and must therefore be ingested. It’s found in a wide variety of fruits and vegetables and its regular use is recommended for a number of diseases and to improve general health. When it comes to the use of vitamin C to prevent complex regional pain syndrome (CRPS) in patients with distal radial fractures, however, debate exists and a common consensus has not yet been reached. CRPS, which is characterized primarily by unexplained pain, swelling and loss of joint mobility, occurs frequently after distal radial fractures, with some studies reporting it in as many as 37% of all cases. To better understand the role of vitamin C use in reducing the incidence of CRPS, two randomized control trials (RCTs) were analyzed, and results were generally positive.
Proven effectiveness at certain levels
Two landmark RCTs demonstrated vitamin C to be effective in reducing CRPS in distal radial fractures. One trial used a sample size of 416 patients with 427 wrist fractures and administered a placebo, 200, 500 or 1,500 mg of vitamin C to subjects daily for 50 days. Incidence of CRPS was 10.1% in the placebo group and only 2.4% in the vitamin C group. A statistically significant difference wasn’t noticed between the placebo group and the 200 mg group, and a plateau was reached at 500 mg, suggesting that a 500 mg daily dose is sufficient. The findings support the theory that vitamin C will alleviate problems with pain and stiffness if taken regularly compared to cases where it’s not taken. Based off the high level of evidence used (two RCTs), the study holds more strength than if it were derived from an expert opinion or limited cases.
Some have raised questions regarding the specific dynamics of vitamin C and CRPS, making a case that their relationship needs to be investigated more closely. One thing, however, is for certain: the potential downsides of taking vitamin C are limited, and negative side effects usually occur only when daily dosage exceeds 1,000 mg or with patients on dialysis. Therefore, a specific dosage of 500 mg of vitamin C daily for 50 days is recommended for patients with distal radial fractures to reduce the risk for CRPS and for its general benefits to human health. Further research is required and vitamin C supplements don’t negate the need for proper casting and other proper care for fractures, but its low cost, minimal side effects and proof of effectiveness make it a worthwhile measure.
-Summarized by Greg Gargiulo
-As reported in The Journal of Hand Surgery