[Operative treatment of distal radial fractures under vitamin K antagonist or DOAC : Is preoperative interruption of these drugs necessary?] / Die operative Versorgung distaler Radiusfrakturen unter Marcumar oder DOAC : Ist ein präoperatives Absetzen der Medikation erforderlich?

BACKGROUND: Scientific data on emergency operations during ongoing treatment with vitamin K antagonists or with direct oral anticoagulants (DOAC) are lacking, because interruption or bridging of this treatment is routinely performed for up to several days. To reduce time delays and to simplify this procedure, we perform operations of distal radial fractures immediately and without interruption of antithrombotic medication. MATERIAL AND METHODS: For this retrospective and monocentric study, we included only patients with distal radial fractures treated within 12 h after diagnosis with open reduction and volar plating and who received anticoagulation with a vitamin K antagonist or DOAC. Primary aim of the study was evaluation of specific complications, such as revision due to bleeding or hematoma formation and secondary aims were thromboembolic events or infections. The endpoint was 6 weeks after the operation. RESULTS: Between 2011 and 2020, 907 consecutive patients with distal radial fractures were operatively treated. Of these, 55 patients met the inclusion criteria. The mean age was 81.5 Jahre (63-94 years) and women (n = 49) were primarily affected. All operations were performed without tourniquets. With a study endpoint 6 weeks after operation, no revisions were performed for bleeding, hematoma, or infection and primary wound healing was assessed for all patients. One revision was performed for fracture dislocation. Thromboembolic events were also not documented. CONCLUSION: In this study the treatment of distal radial fractures within 12 h and without interruption of antithrombotic treatment was not associated with any imminent systemic complications. This applies to both vitamin K antagonists and DOAC; however, higher case numbers must confirm our results.

Effect of Perioperative Vitamin C on the Incidence of Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis.

Complex regional pain syndrome type 1 (CRPS-I) is a complex complication that occurs after limb extremity surgeries. Controversy exists regarding the effectiveness of vitamin C in reducing that condition. Therefore, we conducted this systematic review and meta-analysis to assess the role of vitamin C on CRPS-I and functional outcomes after distal radius, wrist, foot, and ankle surgeries. We searched Medline (via PubMed), Embase, the Cochrane Library, Clinicaltrial.gov, and Google Scholar for relevant studies comparing perioperative vitamin C versus placebo after distal radius, wrist, foot, and ankle surgeries from infinity to May 2021. Continuous data such as functional outcomes and pain scores were pooled as mean differences, while dichotomous variables such as the incidence of complex regional pain syndrome and complications were pooled as odds ratios, with 95% confidence interval, using R software (meta package, version 4.9-0) for Windows. Eight studies were included. The timeframe for vitamin C administration in each study ranged from 42 to 50 days postinjury and/or surgical fixation. The effect size showed that vitamin C was associated with a decreased rate of CRPS-1 than placebo (odds ratio 0.33, 95% confidence interval [0.17, 0.63]). No significant difference was found between vitamin C and placebo in terms of complications (odds ratio 1.90, 95% confidence interval [0.99, 3.65]), functional outcomes (mean difference 6.37, 95% confidence interval [-1.40, 14.15]), and pain scores (mean difference -0.14, 95% confidence interval [-1.07, 0.79]). Overall, vitamin C was associated with a decreased rate of CRPS-I than placebo, while no significant difference was found regarding complications, functional outcomes, and pain scores. These results hold true when stratifying fracture type (distal radius, ankle, and foot surgeries) and vitamin C dose (500 mg or 1 g).

Effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mineral density, muscle mass, and exercise capacity for postmenopausal women with distal radius fractures.

BACKGROUND: Distal radius fractures are often the first fractures experienced by adults with osteoporosis, and such fractures provide an opportunity for treatment to prevent a domino effect of future fractures. Most of these fractures result from falls, which may be related to the individual's limb muscle mass, strength, and exercise capacity. Active vitamin D3 positively affects muscle and bone mass. However, the effect of a bone resorption inhibitor is unknown. This study aimed to determine the effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mass, limb muscle mass, and exercise capacity of osteoporotic patients with distal radius fractures and to identify the preventive effects against future fractures. METHODS: Participants were postmenopausal women(n = 99) with distal radius fractures who visited the orthopedics outpatient department in a city general hospital from April 2015 to October 2017. Bone mass, limb muscle mass, skeletal muscle mass index, and muscle strength (grip strength and quadriceps muscle strength), walking speed, 2-step results, and timed up and go tests results were evaluated before and after 1 year of treatment. The instances of fall recurrence and refracture were investigated using a questionnaire. RESULTS: Eighty-five patients completed follow-up assessments for 1 year. After treatment, bone mass and bone mineral density were significantly improved in the lumbar spine and total proximal femur compared to before treatment. Furthermore, skeletal muscle mass index, grip strength on the unaffected side, quadriceps muscle strength, walking speed and 2-step test results after 1 year of treatment were significantly improved. Nineteen and 4 patients experienced fall recurrence and refracture, respectively. CONCLUSIONS: Eldecalcitol alone or a bone resorption inhibitor with eldecalcitol improved bone mass and bone mineral density, and maintained skeletal muscle mass index, muscle strength, and exercise capacity of osteoporotic patients with distal radius fractures.

Uncomplicated Distal Radius Fractures: An Opportunity to Reduce Emergency Medicine Opioid Prescribing?

OBJECTIVES: To assess emergency physician prescribing for simple extremity fractures-specifically, distal radius fractures-and describe the opportunity for reducing opioid prescribing. METHODS: An electronic survey was distributed to 1238 emergency physicians employed by a nationwide practice serving 220 sites in 20 states. The survey presented two plain film views of a simple Colles fracture and asked: "For the last patient you discharged . . . with the above injury, which pain medications did you prescribe or recommend?" Responses were collected using a clickable checklist of common opioid and nonopioid pain medications. Respondents also specified the number of days covered by any prescription. We assessed associations between physician characteristics and opioid prescribing using the χ2 test, the Wilcoxon rank-sum test, and multivariable regression models. RESULTS: Responses were received from 447 (36%) physicians working in 18 states; 93% were trained in emergency medicine, 33% worked at academic sites, 68% had site volumes between 25,000 and 75,000, and the median experience was 10 (interquartile range 5-19) years. Overall, 92% (95% confidence interval 89%-95%) had prescribed an opioid for a median of 3 (interquartile range 3-4) days. The most commonly prescribed opioids were hydrocodone/acetaminophen (55%) and oxycodone/acetaminophen (20%). Physicians at academic sites prescribed opioids less frequently than those at nonacademic sites (88% vs 94%), but in multivariable regression there were no significant associations between physician characteristics and opioid prescribing. CONCLUSIONS: Emergency physicians commonly prescribe opioids for simple distal radius fractures. This represents a potential opportunity to reduce opioid prescribing.

Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan.

INTRODUCTION: This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture. MATERIALS AND METHODS: Between 2014-2015, among 294,374 eligible individuals (42% female) aged 50-75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate. RESULTS: The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08-10.07, OR: 2.77, 95% CI: 1.24-6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%). CONCLUSION: The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.

A Biomechanical Comparison of Three Miniature Locking Plate Systems in a Rabbit Radial and Ulnar Fracture Model.

OBJECTIVE: The aim of this study was to evaluate the biomechanical properties of three different miniature locking plate systems used to fixate radial and ulnar fractures in toy breed dogs. Implant size, shape, material and locking systems differ, and their influence on the fracture healing process is unknown. In the present study, we aimed to investigate this matter in vivo using rabbit radial and ulnar fracture models. STUDY DESIGN: Eighteen rabbits were randomly divided into three groups, and the left radius and ulna were osteotomized to create fracture models. The osteotomies were then fixated using either the TITAN LOCK 1.5, Fixin micro or LCP 1.5 system. Radiographs were obtained 2, 3 and 4 weeks after surgery. Four weeks after surgery, the radiuses were collected and used for biomechanical testing or histological examinations. RESULTS: During the 4 weeks of observation, no adverse effects due to the implants occurred. The radiographic scores in each group did not differ significantly at any time point. The maximum load in the LCP group was significantly higher than that in the TITAN and Fixin groups. There was no significant difference in bending stiffness or work to failure among the groups. Initial fracture healing via woven bone was evident at histological evaluation. CONCLUSIONS: All three miniature locking plate systems provided adequate fracture stabilization 4 weeks after surgery, despite their differences, in rabbit models.

Hematoma block for distal radius fractures - prospective, randomized comparison of two different volumes of lidocaine.

OBJECTIVE: This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. METHODS: Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. RESULTS: Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32-87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. CONCLUSION: VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

Propolis extract a new reinforcement material in improving bone healing: An in vivo study.

BACKGROUND: Propolis is known for its antioxidant, immune response modulating, and wound healing effects. In the present study in order to determine the bone healing capacity of the propolis extract, a critical sized, nonunion, radial bone defect model was repaired in rat, using chitosan and demineralized bone matrix (DBM) scaffolds along with propolis extract. MATERIALS AND METHODS: Seventy-two radial bone defects in 36 healthy male rats were randomly divided into 6 groups (n = 12/group). The groups included autograft, defect or untreated group, chitosan, DBM, chitosan and propolis (chitosan-propolis), and DBM and propolis (DBM-propolis). The bone repairing capability was characterized using radiography at 28th, 42nd and 56th postoperative days. Gross morphologic, histopathologic, histomorphometric and biomechanical examinations were performed following euthanasia at the 56th post-operative day. RESULTS: The DBM-propolis group, showed better structural and biomechanical properties compared to the untreated, DBM, chitosan and chitosan-propolis groups. The defect site in the chitosan and untreated groups were mainly restored by fibrous connective tissue while the lesions in the autograft group were mostly filled by cartilage and a lesser amount of woven bone. The woven bone, and the hyaline cartilage were the main constituents of the newly formed tissues in the DBM-propolis group, at the 56th day after injury. CONCLUSION: The results of this study showed that percutaneous injection of diluted aqueous propolis extract in the bone defect (25 mg/defect) can improve bone formation in the critical radial bone defect in rat. Since there was no significant difference between the autograft and DBM-propolis group, probably this therapeutic strategy has high potential in augmentation of autologous bone grafting.

Comparative adherence to weekly oral and quarterly intravenous bisphosphonates among patients with limited heath literacy who sustained distal radius fractures.

Individuals with limited health literacy (HL) are less likely to obtain preventive care. We designed a study to compare adherence to weekly oral and quarterly intravenous bisphosphonates among patients with low HL. The study enrolled a total of 432 female patients who presented with a distal radius fracture caused by low-energy trauma. Participant HL was measured using the Newest Vital Sign tool, and patients were randomized to weekly oral or quarterly intravenous bisphosphonate groups. Subjects in the intravenous bisphosphonate group received intravenous injections of 3 mg ibandronate every 3 months, and those in the oral bisphosphonate group self-administered 70 mg alendronate orally once each week for 12 months. The adherence to weekly oral or quarterly intravenous bisphosphonates was analyzed by HL level. The rate of adherence to quarterly intravenous bisphosphonates was significantly higher than that for weekly oral bisphosphonates in patients with inadequate HL (73 vs. 46%, p = 0.001), whereas no significant differences were observed between HL groups in adherence to intravenous bisphosphonate. Conversely, the rate of adherence to orally administered bisphosphonates was significantly lower in patients with inadequate HL than in those with appropriate HL (46 vs. 65%, p = 0.005). After controlling for confounding variables, inadequate HL, the presence of comorbidities, and weekly oral bisphosphonates were associated with a higher likelihood of nonadherence to osteoporosis treatment. Thus patients with limited health literacy can achieve rates of adherence to quarterly intravenous bisphosphonates, as opposed to weekly oral bisphosphonates, similar to rates among patients with appropriate literacy.

The Efficacy of Vitamin C in the Prevention of Complex Regional Pain Syndrome After Distal Radius Fractures: A Synthesis.

The current recommendation is to use daily doses of vitamin C to prevent the occurrence of the complex regional pain syndrome (CRPS) following a distal radius fracture. The study is a synthesis of the four primary studies that examine this issue. These studies have been previously examined in the meta-analysis literature. The incidence of CRPS is lower in patients treated with the vitamin C protocol compared with the control. The significance of the difference varies from P = .02 to P = .13. Our analysis points to the fact that the relative efficacy of vitamin C has decreased over the past 15 years (P < .001). In 2014, the incidence of CRPS in the vitamin C cohort is not statistically different from the incidence in the control group (P = .76). Vitamin C has lost its relative efficacy.

Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014.

STUDY OBJECTIVES: To evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures. METHODS: This is a retrospective cohort study of pediatric patients in KKWomen's and Children's Hospital Children's Emergency Department with forearm fractures between Jan 2003 and Dec 2014 who underwent manipulation and reduction using Bier's block. Demographic data, time from registration to discharge, major complications and success rate were collated in a standardized data collection form. A subanalysis of the Bier's block group from 2009 to 2014 was performed and compared to a corresponding data set of paediatric patients who underwent manipulation and reduction of forearm fractures using ketamine for procedural sedation from 2009 to 2014. RESULTS: 1781 cases of paediatric forearm fractures were analysed. The mean age of patients in the Bier's block group was 12.0 years (range 5.5-17.8 years old). Of all patients undergoing Bier's block, 1471 out of 1781 patients were male (82.7%). The mean length of stay (LOS) in the department was 168±72min, measured from time of registration till departure. From our subanalysis of data from 2009 to 2014, the mean LOS for the Bier's block group was shorter - 170min compared to 238min for the ketamine group (P <0.0001). 2 patients had failed Bier's block which required a repeat procedural sedation using ketamine. 96% of patients who underwent Bier's block were discharged with an outpatient orthopaedic appointment. There were no deaths or major complications identified in our study. CONCLUSION: Bier's block is a safe technique for reduction of fractures when used in the appropriate population and fracture types, with a low failure rate and no major complications including death. Compared to the ketamine group, it has a shorter length of stay in the emergency department. We recommend the adoption of this practice for manipulation and reduction of pediatric forearm fractures in the Emergency Department with a formalised protocol to reduce and prevent any human errors that can potentially result in complications.

Effectiveness of tissue engineered based platelet gel embedded chitosan scaffold on experimentally induced critical sized segmental bone defect model in rat.

BACKGROUND: Healing and regeneration of large bone defects are a challenging problem for reconstructive orthopedic surgeons. PURPOSE: This study investigated the effectiveness of chitosan scaffold (CS), platelet gel (PG) and their combination (CS-PG) on healing process of an experimentally induced critical sized segmental bone defect model in rat. METHODS: Fifty bilateral defects were created in the mid diaphysis of the radial bones of 25 Sprague-Dawley rats. The animals were randomly divided into five equal groups. The bone defects were either left untreated or treated with corticomedullary autograft, CS, PG or CS-PG. Plain radiographs were provided from the radial bones on weeks 2, 5, and 8 after injury. In addition, clinical examinations were done for the healing radial bones. The animals were euthanized after 8 weeks of injury, and their harvested samples were evaluated by gross morphology, histopathology, scanning electron microscopy, CT-scan, and biomechanical testing. RESULTS: Compared with the defect group, the PG and autograft treated bone defects had significantly superior radiological scored values, bone volume and biomechanical performance which had positive correlation with their superior gross pathological, histopathological and ultra-structural features. Compared with the untreated defects, the PG and CS-PG treated defects showed significantly superior structural and functional properties so that PG had the highest value. In addition, CS had low value in bone regeneration. Although combination of CS and PG improved the healing efficacy of the CS, this strategy reduced the ability of PG to increase osteoconduction and osteoinduction during bone regeneration. CONCLUSION: Application of PG alone enhanced bone healing and can be regarded as a promising option for bone tissue engineering in clinical settings. Chitosan was not effective in bone reconstruction surgery and further investigations should be conducted to find a suitable carrier for PG.

The effect of probiotic treatment on elderly patients with distal radius fracture: a prospective double-blind, placebo-controlled randomised clinical trial.

Probiotic treatment has been shown to improve bone formation, increase bone mass density and prevent bone loss. We aimed to assess the effect of probiotic treatment on functional recovery in elderly patients with a distal radius fracture. A total of 417 elderly patients with an acute distal radius fracture were enrolled in this double-blind placebo-controlled clinical trial. They were randomised to receive skimmed milk containing either a commercial probiotic (Lactobacillus casei Shirota) or placebo daily for a period of 6 months after the fracture. Treatment outcomes were the DASH (disabilities of the arm, shoulder and hand) score, pain, complex regional pain syndrome (CRPS) score, active range of motion and grip strength, all of which were measured on a monthly basis. Throughout the duration of the study, DASH score, pain, CRPS score, wrist flexion and grip strength of patients receiving probiotics exhibited a significantly faster pace of improvement than those on placebo, with treatment outcomes of patients receiving Lactobacillus casei Shirota at month 4 at comparable levels with those of patients receiving placebo at month 6. In elderly patients with a fracture of the distal radius, administration of the probiotic could greatly accelerating the healing process.

Treatment of Infected Forearm Nonunions With Large Complete Segmental Defects Using Bulk Allograft and Intramedullary Fixation.

PURPOSE: The purpose of this study is to report the results of a series of infected forearm nonunions treated from 1998 to 2012 using a staged reconstruction technique. METHODS: At a median of 42 months follow-up, 7 patients who had an average segmental defect of 4.9 cm (range, 2.3-10.4 cm) were available for clinical and radiographic evaluation. Treatment consisted of serial debridement, implantation of an antibiotic cement spacer, and staged reconstruction using a bulk radius or ulna allograft with intramedullary fixation. RESULTS: All 7 patients ultimately achieved solid bone union, although 4 patients (57%) required additional surgery, consisting of autologous bone grafting and plating, to achieve healing at 1 of the allograft-host junction sites. No patient had recurrence of infection, and all reported substantial improvement with increased function and decreased pain. CONCLUSIONS: Our approach ultimately resulted in a 100% union rate without recurrence of infection, although many patients may require additional surgery to attain healing at both allograft-junction sites. Using bulk allograft provides the ability to span a large defect while reconstituting the forearm anatomy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Increased bone formation in a rabbit long-bone defect model after single local and single systemic application of erythropoietin.

Background and purpose - Delayed bone healing with non-union is a common problem. Further options to increase bone healing together with surgery are needed. We therefore evaluated a 1-dose single application of erythropoietin (EPO), applied either locally to the defect or systemically during surgery, in a critical-size rabbit long-bone defect. Material and methods - 19 New Zealand White rabbits received a 15-mm defect in the radius diaphysis. An absorbable gelatin sponge was soaked with saline (control group and systemic treatment group) or EPO (local treatment group) and implanted into the gap. The systemic treatment group received EPO subcutaneously. In vivo micro-CT analysis was performed 4, 8, and 12 weeks postoperatively. Vascularization was evaluated histologically. Results - Semiquantitative histomorphometric and radiological evaluation showed increased bone formation (2.3- to 2.5-fold) in both treatment groups after 12 weeks compared to the controls. Quantitative determination of bone volume and tissue volume showed superior bone healing after EPO treatment at all follow-up time points, with the highest values after 12 weeks in locally treated animals (3.0- to 3.4-fold). More vascularization was found in both EPO treatment groups. Interpretation - Initial single dosing with EPO was sufficient to increase bone healing substantially after 12 weeks of follow-up. Local application inside the defect was most effective, and it can be administered directly during surgery. Apart from effects on ossification, systemic and local EPO treatment leads to increased callus vascularization.

[Efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures].

Xiatianwu tablet is based on the theory of traditional Chinese medicine (TCM), combined with modern TCM pharmacology and selected 33 famous traditional Chinese crude drugs to compose. Its recipe helps cure rheumatism, relax tendons, promote blood circulation to relieve pain, et al. Although Xiatianwu tablets are widely applied to clinical remedy such as rheumatic arthritis, lumbar disc hernia, osteoarthritis and so on, there is no report about its application in fracture. This article is to observe the efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures and its impact on the wrist function and complications. 180 elderly patients with osteoporotic distal radius fractures, from January 2011 to June 2014, were divided into observation group and control group by the method of random number table, each group had 90 cases. The control group were gave Caltrate D after manipulative reduction and plaster immobilization, observation group were treated with compound Xiatianwu tablets in the basis of the control group. Efficacy, wrist function and complication rates were observed in two groups after treatment. The excellent and good rate was 95.56% in observation group better than 77.78% in control group, the difference was statistically significant (χ2 = 4.712, P < 0.05). The complication rate in observation group was significantly lower compared with the control group (P < 0.05). This study shows that compound Xiatianwu tablets can improve the efficacy in elderly patients with osteoporotic distal radius fractures, reduce the incidence of complications and relieve the pain of patients which plays a significant role in improving the quality of life.

Vitamin C to Prevent Complex Regional Pain Syndrome in Patients With Distal Radius Fractures: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: To determine whether vitamin C is effective in preventing complex regional pain syndrome (CRPS) in patients with distal radius fractures. DATA SOURCES: MEDLINE (1946 to present), EMBASE (1974 to present), and The Cochrane Library (no date limit) were systematically searched up to September 6, 2014, using MeSH and EMTREE headings with free text combinations. STUDY SELECTION: Randomized trials comparing vitamin C against placebo were included. No exclusions were made during the selection of eligible trials on the basis of patient age, sex, fracture severity, or fracture treatment. DATA EXTRACTION: Two reviewers independently screened articles, extracted data, and applied the Cochrane Risk of Bias tool. Evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Heterogeneity was quantified using the χ test and the I statistic. Outcome data were combined with a random effects model. RESULTS: Across 3 trials (n = 890) of patients with distal radius fractures, vitamin C did not reduce the risk for CRPS (risk ratio = 0.45; 95% confidence interval, 0.18-1.13; I = 70%). This result was confirmed in sensitivity analyses to test the importance of missing data because of losses to follow-up under varying assumptions. Heterogeneity was explained by diagnostic criteria, but not regimen of vitamin C or fracture treatment. CONCLUSIONS: The evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences.

[Clinical Efficacy of Supplementary Treatment of Gukang Capsules to the Elder Patients with Fracture of Distal Radius].

OBJECTIVE: To study the clinical efficacy of supplementary treatment of tukang Capsules to the elder patients with fracture of the distal radius. METHODS: A total of 108 elder patients with fracture of the distal radius diagnosed by X-ray,who visited orthopedics department of Pu' ai Hospital in January 2012 - December 2013, were randomly divided into observation group and control group. Cases in both groups received the operation of internal fixation by T-type plate. Cases in control group received oral Calcium Carbonate Tablets, and cases in observation group received Gukang Capsules besides Calcium Carbonate Tablets. Treatment duration was four weeks. The painful and swelling degree of wrist joints, levels of type I propeptide carboxy-terminal procollagen (P I CP) and bone glaprotein(BGP) in serum were compared. Hospitalization and fracture healing time, as well as recovery condition of wrist joints in the sixth month after operation were compared. RESULTS: The VAS of both groups was not significantly different before operation and in the 28th day after operation(P >0. 05), but the VAS in observation group was significantly lower than that in control group in the 3rd,5th, 7th, 14th and 21th day after operation(P <0. 01). The swelling scale of both groups was not significantly different before operation and in the 28th day after operation(P >0. 05), but the swelling scale in observation group was significantly lower than that in control group in the 3rd, 5th, 7th, 14th and 21th day after operation(P <0. 01). The levels of P I CP and BGP in serum of both groups were not significantly different before operation(P >0. 05), but the levels of P I CP and BGP in serum of observation groups were significantly higher than that in control group one and two months after operation (P <0. 01). Hospitalization and fracture healing time in observation group was significantly shortened compared with control group (P <0. 05). The effective ratio in observation group was 79. 63%, significantly higher than that in control group (P <0. 05). CONCLUSION: Gukang Capsules supplementary to internal fixation by T-type plate has favorable efficacy to fracture of the distal radius, which can reduce pain and swelling, increase levels of P I CP and BGP in serum, as well as promote the heal of fracture and recovery of wrist joints function.

Analgesic effect of nasal salmon calcitonin during the early post-fracture period of the distal radius fracture.

OBJECTIVES: To investigate the analgesic effect of nasal salmon calcitonin on the post-fracture period of distal radius fracture. METHODS: In this prospective randomized double-blind study, forty-one postmenopausal women with a recent distal radius fracture treated conservatively were randomly assigned to receive either 200 IU of intranasal salmon calcitonin or placebo daily for 3 months following fracture. The assessment of the patient's pain was recorded using the Visual Analogue Scale (VAS). RESULTS: The average age of the calcitonin group was 67.11 (SD, ±8.68) years and 64.91 (SD, ±7.48) of the placebo group. In the calcitonin group, the mean VAS score improved from 4.05 to 0.53 while in the placebo group from 3.36 to 0.32. A higher decrease of VAS score during the first post-fracture period was observed in the calcitonin group. CONCLUSIONS: In the study, there is a statistically significant calcitonin mediated analgesic effect in the immediate post fracture period (at 10 days) when compared to placebo group. These results are in accordance with literature referring to the analgesic effect of calcitonin in the acute osteoporotic vertebral compression fracture. Thus calcitonin administration could be recommended to a short term course in acute osteoporotic conservatively treated distal radius fractures.