The influence of vitamin C on the outcome of distal radial fractures: a double-blind, randomized controlled trial.

BACKGROUND: Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture. METHODS: A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score. RESULTS: There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing. CONCLUSIONS: This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

A comparison of RhBMP-7 (OP-1) and autogenous graft for metaphyseal defects after osteotomy of the distal radius.

UNLABELLED: SUMMARY AIM: The aim of the study was to demonstrate whether RhBMP-7 is an effective alternative to autogenous bone graft in the healing of metaphyseal defects in the distal radius following corrective osteotomies for symptomatic malunion after distal radial fractures. PATIENTS AND METHODS: Thirty patients were entered into the study and were randomised to receive either RhBMP-7 or autogenous bone graft harvested from the ipsilateral iliac crest. Stabilisation of the osteotomy was either carried out with non- bridging external fixation or the pi-plate. Clinical, radiographic and functional review were carried out at regular intervals up to 1 year. RESULTS: The first 10 patients were treated using non-bridging external fixation of the osteotomy. Two of the 4 patients treated with RhBMP-7 developed excessive osteolysis around the osteotomy site resulting in loss of the corrected position and non-union of the osteotomy. The other 2 patients healed at 13 weeks. The 6 patients treated with autogenous bone graft all healed at an average of 7 weeks, without any complications. It was postulated that the osteolysis was related to instability of the osteotomy site, and the use of external fixation was abandoned and replaced with internal fixation with a dorsal pi-plate. In the pi-plate group of patients, 10 were treated with autogenous bone graft and 10 with RhBMP-7. The bone graft patients healed at 7 weeks compared to 18 weeks for the RhBMP-7 patients, which was statistically significant (p = 0.019). The patients who received bone graft had complete filling of the metaphyseal defect radiologically. Five patients treated with RhBMP-7 healed at the volar cortex with a dorsal defect remaining at 1 year. Two patients developed non-union radiologically. Ten patients (3 in the RhBMP-7 and 7 in the bone graft groups) required plate removal for soft tissue complications. CONCLUSION: RhBMP-7 does not confer the same stability as bone graft, allowing shear forces across the osteotomy site when used in conjunction with non-bridging external fixation, reducing the capacity for healing and resulting in osteolysis. Using the RhBMP-7 with a pi-plate resulted in healing of the osteotomy, but at a slower rate than autogenous bone graft.

The epidemiology of metatarsal fractures.

BACKGROUND: Metatarsal fractures are common injuries; however little has been written regarding their epidemiology in an adult population. METHODS: All patients with metatarsal fractures during a 1-year time period were included in the study. Demographic information, grade, and mechanism of injury, associated injuries, and fracture location and type were recorded. RESULTS: Three hundred and fifty-five patients with 411 metatarsal fractures were identified. The average age of the patients was 42 years. There was a higher proportion of women in the higher age groups, and the most common fracture was that of the fifth metatarsal. Multiple metatarsal fractures occurred in contiguous metatarsals, and 63% of third metatarsal fractures were associated with a fracture of either the second or fourth metatarsal. CONCLUSION: Knowledge of the epidemiology and injury patterns of metatarsal fractures can aid in the accurate identification and subsequent treatment of fractures of the metatarsals.