The Influence of Vitamin C on the Outcome of Distal Radial Fractures

Abstract

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Vitamin C to Prevent Complex Regional Pain Syndrome in Patients With Distal Radius Fractures

“…10 The mean difference between groups was not statistically significant and did not exceed the MID (mean difference = 1.30 in favor of placebo, 95% CI, 22.12 to 4.72; MID = 10.2 points). Complications were reported in the same trial as a composite that included loss of reduction, paresthesias, superficial infections in surgically treated patients, and tendon injuries.…”

“…1). 6,10,24 Agreement between the reviewers for screening of titles and abstracts was satisfactory (kappa = 0.70). The disagreements resulted because one of the reviewers included commentaries and duplicate publications that the other reviewer excluded.…”

“…24 CRPS was diagnosed according to the criteria of Veldman in 2 studies 6,24 and according to the criteria of Atkins in the third. 10 Two of the studies had statistically significant dichotomous primary outcomes, and their fragility indices were each one event or fewer. 6,24 Risk of Bias All 3 trials were determined to be at low risk of bias (see Figure, Supplemental Digital Content 1, http://links.lww.com/BOT/A302) for each category of randomization, allocation concealment, blinding, and reporting of losses to follow-up.…”

“…the pooled estimate was explained according to the diagnostic criteria that the trials employed. Across 2 trials that used the criteria of Veldman et al, 4 the number of patients needed to treat with vitamin C to prevent CRPS in 1 patient was 11 (95% CI, [9][10][11][12][13][14][15][16][17], whereas the single trial that used the criteria of Atkins et al 5 found no benefit.…”

“…9 However, a more recently published trial reported a conflicting result, and an updated meta-analysis is required to understand differences between studies, detect bias, and direct future research. 10,11 The primary objective of this systematic review and meta-analysis was to determine whether vitamin C is effective in preventing CRPS in patients with distal radius fractures within 1 year of follow-up, based on evidence from randomized controlled trials. Additional objectives were to explore reasons for heterogeneity between trials and evaluate the overall quality of the current evidence.…”