I’ve been treating a patient recently who broke a bone in their wrist. Their physiotherapist advised them to take vitamin C daily for the next seven weeks to prevent pain post-operatively. It sounds like an unusual recommendation, but there’s actually a reasonable body of evidence behind it, and the condition it is trying to prevent is one worth knowing about… despite vitamin C not being the first thing most people associate with fracture management.
Before we get started, I just want to remind you that a broken bone and a fractured bone are the same thing! When I was younger, I thought a fractured bone was a ‘hairline crack’ and a broken bone was a much more severe version of this. However, ‘fracture’ is just the medical term for a break.
Complex regional pain syndrome (CRPS) is a chronic pain condition that can develop after injury or surgery to a limb. It causes severe burning pain, swelling, and changes in skin colour and temperature, and it can be completely debilitating. There is currently no reliable cure, and treatment is notoriously difficult. Prevention, therefore, is the priority.
The theoretical basis for vitamin C is that CRPS is thought to involve oxidative stress where free radicals damage blood vessels and nerves in the injured limb. Vitamin C is a potent antioxidant, and the hypothesis is that supplementation during the vulnerable post-injury period could neutralise these reactive oxygen species and protect the microvasculature.
A randomised controlled trial published in 2007 enrolled 416 patients with wrist fractures and found that 500mg of vitamin C daily for 50 days reduced CRPS incidence from 10% in the placebo group to 2.4% in the vitamin C group. Several subsequent systematic reviews broadly supported this, particularly for wrist fractures. The American Academy of Orthopaedic Surgeons included it in their 2010 clinical practice guidelines as a moderate strength recommendation for distal radius fractures. A more critical systematic review published in 2023, however, suggested the effect may be more modest than earlier literature implied, and the evidence for injuries other than wrist fractures remains limited.
Where that leaves us is a familiar place in medicine: a treatment that is cheap, widely available, and carries minimal risk, with evidence that is encouraging but imperfect. The main side effects are gastrointestinal discomfort, and kidney stones are only a concern at very high doses over a prolonged period. Given how difficult CRPS is to manage once it’s established, discussing vitamin C 500mg daily for 50 days with your doctor after a wrist fracture or wrist surgery is a reasonable conversation to have. It’s not a guaranteed solution, it will not treat established CRPS, and the evidence does not yet support recommending it for all orthopaedic injuries. But as preventive measures go, it is one of the more accessible ones on the table.
👋 For the new joiners: I’m Suraj, also known as Dr Sooj - a primary care doctor & health content creator. I love navigating the complex world of health and wellness and breaking down complicated concepts.
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References:
1. Zollinger PE, et al. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? J Bone Joint Surg Am. 2007;89(7):1424–31.
2. Shibuya N, et al. Efficacy of vitamin C on complex regional pain syndrome type I. J Foot Ankle Surg. 2013;52(1):62–6.
3. Chen S, et al. Efficacy of vitamin C for the prevention of CRPS after distal radius fracture. Clin J Pain. 2016;32(2):179–85.
4. American Academy of Orthopaedic Surgeons. Clinical Practice Guideline on the Treatment of Distal Radius Fractures. 2010.
5. Aynehchi BB, et al. Efficacy of vitamin C in the prevention or treatment of complex regional pain syndrome: a systematic review. Br Med Bull. 2023;148(1):5–16.