Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?

Vitamin C metabolites, independent of smoking status, significantly enhance leukocyte, but not plasma ascorbate concentrations

“…36,37 Additionally, vitamin C has been the sole component in some positive and large randomized trials that may change other disciplines of medicine, such as orthopedics, due to its potential to prevent complex regional pain syndrome in individuals who have recently suffered from wrist fractures. 38,39 Vitamin C is also currently a part of one of the largest primary prevention trials in human history that seeks to determine its clinical impact on cardiovascular disease, cancer, and eye disease by itself or as part of a combination of supplements. 5 Thus, improving and utilizing other tangible blood and tissue markers of vitamin C to predict clinical outcomes in patients seems imperative, especially since plasma and red blood cell levels of this vitamin are tightly controlled.…”

Use of Oral Vitamin C After Fractures of the Distal Radius

“…[1][2][3] Vitamin C, also known as ascorbic acid, is a water-soluble organic compound first identified in 1932. Although humans are unable to synthesize vitamin C, it is an essential micronutrient in many enzymatic and chemical pathways.…”

“…1,2 In the most recent trial, 416 patients with 427 wrist fractures were randomized to treatment with placebo or treatment with 200, 500, or 1500 mg of vitamin C daily for a period of 50 days. The prevalence of CRPS type I was 10.1% in the placebo group and 2.4% in the vitamin C group (pϭ.002).…”

“…Patients with early cast complaints were far more likely to develop CRPS (relative risk, 5.35). 2 However, the primary concern revolves around the diagnosis of CRPS. Although the 2 trials used the diagnostic criteria suggested by Veldman et al, 8 there are alternative sets of criteria published in the literature.…”

“…Owing to a lack of precision in the diagnosis of CRPS, Zollinger et al acknowledged that whereas vitamin C ameliorates the Veldman signs and symptoms, it may not prevent CRPS. 2 In addition, there is a lack of clarity regarding the mechanism by which vitamin C acts to decrease the incidence of CRPS. 3 Toxic oxygen radicals are thought to be involved in the pathogenesis of CRPS, 11 and their production in neutrophils is reduced in the presence of vitamin C. 12 The role of vitamin C has been studied in other inflammatory processes.…”