Use of oral vitamin C after fractures of the distal radius.

i t w c C C HERE HAS BEEN considerable debate regarding the effect of vitamin C on the prevention of complex regional pain syndrome (CRPS) in the etting of distal radius fractures. Vitamin C, also nown as ascorbic acid, is a water-soluble organic comound first identified in 1932. Although humans are nable to synthesize vitamin C, it is an essential microutrient in many enzymatic and chemical pathways. itamin C acts as a cofactor for 8 different enzymes hat are involved in collagen hydroxylation, carnitine nd norepinephrine biosynthesis, amidation of peptide ormones, and tyrosine metabolism. In addition, vitain C acts as a powerful chemical reducing agent, or ntioxidant. Vitamin C is found in a large number of vegetables nd fruits (Table 1). The precise amount of vitamin C n a specific vegetable or fruit varies based on serving ize, season, transport, shelf time, storage, and cooking ractices. If an individual consumes 5 standard servings f vegetables and fruit in a day, daily vitamin C intake ill range from 210 to 280 mg. Complex regional pain syndrome, also known as eflex sympathetic dystrophy or algodystrophy, occurs requently after fracture of the distal radius. Although eported incidence varies from one study to another, the ncidence has been reported to be as high as 25% to 7% in prospective investigations. CRPS is characerized by unexplained pain and swelling, vasomotor nstability, and loss of joint mobility. The pathophysilogy of CRPS remains poorly understood. Two landmark, randomized, controlled trials by Zolinger et al. demonstrated that vitamin C reduces the