The Effects of Supplemental Vitamin C in Mandibular Fracture Patients: A Randomized Clinical Trial

Abstract

Vitamin C is an oxidative stress mediator and essential cofactor in wound healing. The objective of this study was to investigate the clinical and biochemical effects of vitamin C supplementation on outcomes in patients undergoing mandibular fracture repair. We also aimed to evaluate the effects of sociodemographic, fracture, and treatment characteristics on post-operative clinical outcomes in these patients. The investigators conducted a double-blind, placebo-controlled, randomized clinical trial at Two Metropolitan, Level 1 Trauma Centers to prospectively evaluate the effects of vitamin C vs. placebo in a mandibular fracture population stratified by smoking and fracture status (open vs. closed). The study was conducted at two safety-net hospitals, enrolling a cohort of heavily underserved patients. Forty-five subjects were evaluated. We found decreased overall post-operative complications, decreased wound infection, and some improved bone healing outcomes in the vitamin C group compared to placebo, however, none of these outcomes reached statistical significance. Vitamin C intervention showed a signal of improved clinical and biological wound healing which was not statistically significant. Additionally, significant associations between patient characteristics and post-operative outcomes were identified. Older subjects and those with co-existent trauma were more likely to have increased healthcare utilization, and increased time from injury to surgery was significantly associated with frank infection. Prescription of additional opioids outside of standard practice was significantly associated with a need for additional wound care, increased emergency room visits, and any post-operative complication. Further investigation is needed to evaluate these findings in a larger study population, yet Vitamin C remains a low-risk, inexpensive potential means to improve wound healing outcomes after acute facial trauma.