In This Article
- Results of the primary outcome—the distance between the fingertip and distal palmar crease six weeks after fracture—show administration of vitamin C was not associated with improved range of motion, function or pain scores at six weeks
- Researchers studied 134 participants in a double-blind, placebo-controlled trial
- All were treated two weeks after distal radius fracture with once-daily 500mg vitamin C or placebo
There is popular interest in using vitamin C following distal radius fracture to improve outcomes, but current evidence used to support this belief is questioned because of the subjectivity of prior studies.
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To further understand this question, a team led by Neal Chen, MD, chief of the Hand & Arm Center in the Department of Orthopaedics at Massachusetts General Hospital, devised and conducted a best-practices clinical trial assessing the therapeutic efficacy of vitamin C to reduce pain and stiffness following distal radius fracture.
Overcoming Evidence Gaps
Dr. Chen's research team is conducting multiple clinical and biomechanical studies to provide insight into important questions in hand surgery. Their research approach leverages extensive multidisciplinary expertise, collaborations with other leading institutions and the use of advanced imaging to improve our understanding of common clinical problems and their treatments.
In this study, the Mass General team collaborated with expert clinical researchers from the University of Texas at Austin and the Netherlands. The rigorous experimental design led to the study's recognition as one of the "Best Papers" at the American Society for Surgery of the Hand meeting in Las Vegas, 2019. The results of the study are published in Clinical Orthopaedics and Related Research.
In their clinical trial, the team used a surrogate for the diagnosis of distal radius fracture. Between August 2014 and July 2017, they followed 134 study participants and measured changes in finger stiffness in response to vitamin C therapy or placebo.
The two research questions they investigated are:
- Is administering vitamin C after distal radius fracture associated with a better range of motion, patient-reported upper extremity function and pain scores?
- What factors are associated with post-fracture finger stiffness and worse upper extremity function?
Participants were randomized to two double-blind study arms of 67 patients each. All were treated two weeks after distal radius fracture, receiving once-daily 500 mg vitamin C or once-daily placebo. All patients received typical discretionary care from their provider. Participant characteristics include mean age of 49 ± 17 years; 99 women patients (74%); 83 treated nonoperatively (62%).
As the primary outcome measure, the team evaluated the distance between the fingertip and distal palmar crease six weeks after fracture.
Secondary outcomes were total active finger motion, total active thumb motion, upper extremity-specific limitations and pain intensity.
Results show that administering vitamin C was not associated with improvement of range of motion, function or pain scores at six weeks. These data lead researchers to conclude that vitamin C does not appear to facilitate recovery after distal radius fracture—a finding Dr. Chen finds clinically useful because the statistical power and strict study design offer clinicians highly reliable decision-making framework.
"Hopefully it may change practice and minimize some of the confusion that has existed around vitamin C therapy for this diagnosis," he says.
Other Creative Collaborations
The vitamin C work is a testament to the creativity that arises from the broad expertise within multidisciplinary teams. In addition to vitamin C study, Dr. Chen and colleagues are pursuing biomechanical studies informed by advanced CT scanning technologies as well as common clinical problems.
One area of interest is determining how radial head surgery affects the development of arthritis in the elbow. "One way of treating a radial head fractured into multiple fragments is by excising the radial head, and there has been debate on whether excision leads to the development of arthritis," says Dr. Chen. "Our CT work preliminary studies suggest that excision of the radial head leads to changes in the forces experienced in the elbow and ultimately lead to arthritis."
An additional area of interest is predicting the healing time of scaphoid fracture of the wrist in the setting of a late diagnosis. "We have theorized that some CT findings may predict whether a scaphoid fracture will heal or not when a patient comes into the clinic at four to six weeks after injury. We hope this method going to be very useful clinically."
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