Post-operative Methylprednisolone Taper Course for Distal Radius Fractures: Early Results of a Randomized Control Trial
Campbell C Collier, BS1, Kevin Xavier Farley, BS2, Charles A Daly, MD2, Eric R Wagner, MD, MS1 and Michael Brandon Gottschalk, MD2, (1)Emory University, Department of Orthopaedics, Atlanta, GA, (2)Emory University, Atlanta, GA
Introduction
Perioperative glucocorticoids have been used as a successful non-opioid analgesic adjunct for various orthopaedic procedures. Here we describe an ongoing randomized control trial assessing the efficacy of a post-operative methylprednisolone taper course on immediate post-operative pain and function following surgical distal radius fixation.
Methods
This study is a randomized control trial (NCT03661645) of a group of patients treated surgically for distal radius fractures. Patients were randomly assigned at the time of surgery to receive intraoperative dexamethasone only or intraoperative dexamethasone followed by a 6-day oral methylprednisolone (Medrol) taper course. A pain journal was used to record visual analog pain scores (VAS-pain), VAS-nausea, and number of opioid tablets consumed during the first 7 post-operative days (POD). Patients were seen at 2-weeks, 6-weeks, and 12-weeks post-operatively for clinical evaluation and collection of patient reported outcomes.
Results
28 patients were enrolled from October 2018 to May 2019. 13 patients have been assigned to the control group and 15 patients have been assigned to the treatment group. There were no differences in age (p=0.370), Body Mass Index (p=0.361), race (p=0.173), comorbidities (p=0.583), smoking status (p=0.206), or pre-operative narcotic use (p=0.445) between cohorts. 78.6% (n=22) of patients were female and the median age was 60.1 years. No differences were seen in pre-operative qDASH (p=0.255) or pre-operative PRWE (p=0.375) between groups. In the 7 days following surgery, patients in the control group took an average of 15.7 (±12.2) opioid tablets, while those in the treatment group took an average of 11.4 (±7.9) tablets (p=0.288). Patient pain scores decreased uniformly in both groups to post-operative day 7. Patient pain was equivalent from POD0 to POD3 (p=0.064 to 0.271). However, from POD4 to POD7 patients receiving the methylprednisolone taper course reported decreased pain (p=0.006 to 0.036) (Figure 1). There was no difference in qDASH score improvement at 6 or 12 weeks. Additionally, no differences were seen for wrist motion improvement at 6 or 12 weeks.
Discussion and Conclusion
A methylprednisolone taper course shows promise in reducing acute pain in the immediate post-operative period following distal radius fixation. Furthermore, although no statistically significant reductions in post-operative opioid utilization were noted, current trends may become statistically significant as the study continues. No improvements were seen in wrist motion or qDASH and continued enrollment of patients in this clinical trial will further elucidate the role of methylprednisolone for these outcomes.
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