• Nathan Evaniew, Colm McCarthy, Ydo V Kleinlugtenbelt, Michelle Ghert, and Mohit Bhandari.
• Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
• J Orthop Trauma. 2015 Aug 1; 29 (8): e235-41.

ObjectiveTo determine whether vitamin C is effective in preventing complex regional pain syndrome (CRPS) in patients with distal radius fractures.Data SourcesMEDLINE (1946 to present), EMBASE (1974 to present), and The Cochrane Library (no date limit) were systematically searched up to September 6, 2014, using MeSH and EMTREE headings with free text combinations.Study SelectionRandomized trials comparing vitamin C against placebo were included. No exclusions were made during the selection of eligible trials on the basis of patient age, sex, fracture severity, or fracture treatment.Data ExtractionTwo reviewers independently screened articles, extracted data, and applied the Cochrane Risk of Bias tool. Evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach.Data SynthesisHeterogeneity was quantified using the χ test and the I statistic. Outcome data were combined with a random effects model.ResultsAcross 3 trials (n = 890) of patients with distal radius fractures, vitamin C did not reduce the risk for CRPS (risk ratio = 0.45; 95% confidence interval, 0.18-1.13; I = 70%). This result was confirmed in sensitivity analyses to test the importance of missing data because of losses to follow-up under varying assumptions. Heterogeneity was explained by diagnostic criteria, but not regimen of vitamin C or fracture treatment.ConclusionsThe evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences.

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