No Higher Risk of CRPS After External Fixation of Distal Radial Fractures - Subgroup Analysis Under Randomised Vitamin C Prophylaxis § ~!2009-11-13~!2010-01-01~!2010-02-17~!

Abstract

Operative and conservative treatment of wrist fractures might lead to complex regional pain syndrome (CRPS) type I.In our multicenter dose response study in which patients with distal radial fractures were randomly allocated to placebo or vitamin C in a daily dose of 200mg, 500mg or 1500mg during 50 days, an operated subgroup was analyzed.48 (of 427) fractures) were operated (11.2%). Twenty-nine patients (60%) were treated with external fixation, 14 patients (29%) with K-wiring according to Kapandji and five patients (10%) with internal plate fixation. The 379 remaining patients were treated with a plaster.In the operated group of patients who received vitamin C no CRPS (0/37) was seen in comparison with one case of CRPS (Kapandji technique) in the operated group who received placebo (1/11 = 9%, p=.23). There was no CRPS after external fixation.In the conservatively treated group 17 cases of CRPS (17/379 = 4.5%) occurred in comparison with one in case of CRPS in the operated group (1/48 = 2.1%, p=.71).External fixation doesn’t necessarily lead to a higher incidence of CRPS in distal radial fractures. Vitamin C may also play a role in this. This subgroup analysis in operated distal radial fractures showed no CRPS occurrence with vitamin C prophylaxis.

A meta-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients

“…The limitations of previous meta-analyses investigating the correlation between oral vitamin C supplementation and the risk of CRPS I are summarized in supplemental Table 1 . For instance, one meta-analysis 22 included only one RCT 44 and two non-RCT studies 42 , 45 without incorporating the results of some RCTs 29 , 33 . Although another meta-analysis focused on RCTs 21 , the included trials involved patients subjected to different forms of treatment (i.e., conservative 33 vs. conservative or surgery 29 , 32 ), inclusion and exclusion criteria, and criteria for diagnosing CRPS I.…”

Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review

“…Studies showed that giving vitamin C for 50 days was superior to placebo in preventing the occurrence of CRPS following wrist fracture surgery. 99 …”