Prophylactic Administration of Vitamin C in Wrist Fractures

Study Description

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Brief Summary:

Complex Regional Pain Syndrome or posttraumatic dystrophy is a pain syndrome which develops after a trauma, surgery or for unknown reason. The incidence after wrist fractures varies in literature from 2 - 37%. The female sex is involved three times as much as the male sex. There is one study in literature which describes a prophylactic effect of vitamin C after wrist fractures. Goal of this study is to search for a dose dependent effect of vitamin C and to replicate these earlier findings.

Condition or disease	Intervention/treatment	Phase
RSD (Reflex Sympathetic Dystrophy); Algodystrophy; CRPS Type I	Drug: ascorbic acid (vitamin C) versus placebo	Phase 4

Detailed Description:

The trial was designed as a multicentre, randomized, controlled study. Three hospitals in the Netherlands participated in this study, using the same experimental design.

Adults (18 years or above) with a wrist fracture who were seen in the emergency department of each hospital were asked to participate in this study. Patients were asked to start the trial medication on the day of the fracture. Two capsules had to be taken once daily for 50 days. Patients were allocated randomly to receive either placebo or a dosage of 200, 500 or 1500 mg of vitamin C daily.

The endpoint of the study was defined as the presence of CRPS at any moment, in the period up to one year after the fracture. All participants and physicians were unaware of the treatment allocation.

Patients were seen after 1 week, 4 or 5 weeks (or when the cast was removed), 6 or 7 weeks, 12 weeks, and 26 weeks. After one year patients were interviewed by telephone or received an inquiry letter with a postage-paid envelope for their reply. The normal fracture treatment, either conservative or operative, was not compromised by the protocol, and if necessary patients were seen more often and/or at other times than planned.

Complex regional pain syndrome was diagnosed when four of the following five symptoms were present throughout an area larger than the wrist, including the area distal to the wrist (hand and fingers), and if they occurred or increased after activity: unexplained diffuse pain, which is not in normal relation to the fracture; difference in skin color relative to the other arm; diffuse edema; difference in skin temperature relative to the other arm; limited active range of motion, unrelated to the stage of fracture treatment. If CRPS was diagnosed, the end point of the study was reached and the protocol was terminated to enable treatment for CRPS.

Study Design

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Study Type :	Interventional (Clinical Trial)
Enrollment :	300 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Double
Primary Purpose:	Prevention
Official Title:	Prophylactic Administration of Vitamin C in Wrist Fractures; a Randomized Placebo Controlled Multicentre Dose-Finding Study of the Incidence of Complex Regional Pain Syndrome
Study Start Date :	January 2001
Study Completion Date :	December 2005

Arms and Interventions

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Outcome Measures

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Primary Outcome Measures :

1. the existence of CRPS until one year after follow-up

Secondary Outcome Measures :

1. difference in outcome and dose (dose comparison) after one year of follow-up

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• wrist fracture
• adult (18 years and older)

Exclusion Criteria:

• no comprehension of the written information
• not able to appear for follow-up (living abroad)

Contacts and Locations

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Locations

Netherlands
Rode Kruis Ziekenhuis, Vondellaan 13
Beverwijk, Netherlands, 1942 LE

Sponsors and Collaborators

Stichting Achmea Slachtoffer en Samenleving

Investigators

Principal Investigator:	Paul E Zollinger, MD	department of orthopedic surgery, Ziekenhuis Rivierenland, Pres Kennedylaan 1, 4002 WP Tiel, the Netherlands

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Additional Information:

homepage of department of orthopaedics of Ziekenhuis Rivierenland, Tiel, the Netherlands 

Publications of Results:

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(9195):2025-8.

ClinicalTrials.gov Identifier:	NCT00296868 History of Changes
Other Study ID Numbers:	SRvB/2001-290/JV
First Posted:	February 27, 2006
Last Update Posted:	February 27, 2006
Last Verified:	December 2005

Keywords provided by Stichting Achmea Slachtoffer en Samenleving:

reflex sympathetic dystrophy; ascorbic acid; primary prevention; radius fractures

Additional relevant MeSH terms:

Complex Regional Pain Syndromes; Reflex Sympathetic Dystrophy; Autonomic Nervous System Diseases; Nervous System Diseases; Peripheral Nervous System Diseases; Neuromuscular Diseases; Vitamins	Ascorbic Acid; Micronutrients; Growth Substances; Physiological Effects of Drugs; Antioxidants; Molecular Mechanisms of Pharmacological Action; Protective Agents