Zollinger PE, Tuinebreijer WE, Kreis RW, Breederveld
RS. Effect of vitamin C on frequency of reflex sympathetic dystrophy in
wrist fractures: a randomised trial.
Lancet. 1999 Dec 11;354:2025-8.
Question: In patients with wrist fractures, does
vitamin C reduce the incidence of posttraumatic reflex sympathetic
dystrophy (RSD)?
Design: Randomized (allocation concealed), double-blind,
placebo-controlled trial with 1-year follow-up.
Setting: A hospital in Beverwijk, The Netherlands.
Patients: 123 patients who were 24 to 88 years of
age (mean age, 57 years in the vitamin-C group and 60 years in the
placebo group), had a fracture of the wrist, and were receiving
conservative treatment (i.e., immobilization by a plaster cast,
after reduction under local anesthesia, if necessary). Exclusion
criteria were fractures with unacceptable reduction or secondary
dislocation. Follow-up was 93%.
Intervention: Patients were allocated to vitamin
C, 500 mg/d in 1 capsule (n = 57), or placebo (n =
66) for 50 days. Treatment began on the day of the fracture.
Main outcome measure: Incidence of RSD (i.e., 4
of the following symptoms were present throughout an area larger than
the wrist: 1) unexplained diffuse pain; difference in 2) skin temperature
or 3) skin color relative to the other arm, 4) diffuse edema, 5)
limited active range of motion [not in relation to the stage of
fracture treatment], and 6) occurrence or increase of these signs
and symptoms after activity).
Results: Fewer patients in the vitamin-C group than
in the placebo group had RSD (P = 0.03 [P value
calculated from data in article]) (Table).
Conclusion: In patients with wrist fractures, vitamin
C reduced the incidence of posttraumatic reflex sympathetic dystrophy.