A Prospective Randomized Controlled Trial of Methylprednisolone for Postoperative Pain Management of Surgically Treated Distal Radius Fractures

Gottschalk, Michael B.; Dawes, Alexander; Hurt, John; Spencer, Corey C.; Campbell, Collier; Toston, Roy; Farley, Kevin X.; Daly, Charles A.; Wagner, Eric R.

doi:10.1016/j.jhsa.2022.06.008

Cited by 7 publications

(4 citation statements)

References 55 publications

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“…27 A recent study by Gottschalk et al found that a postoperative methylprednisone taper significantly reduces pain and opioid consumption after DRF surgery. 28 Many studies have focused nonmedication methods of pain management and emphasized the importance of preoperative education on pain control management and appropriate use of analgesia, finding that it is correlated with fewer readmissions and better follow-up, well-being, and pain indices. 29 Wood et al found that there was a significant reduction in admission rates from 20% to 10% through preoperative education on analgesia and written paperwork to reiterate directions and understanding.…”

Section: Discussionmentioning

confidence: 99%

Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study

Menon,

Payne,

Woodard

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Distal radius fractures (DRFs) commonly require surgical fixation. Unscheduled healthcare contact (UHC) after surgery represents an area of quality improvement in surgical care. We hypothesize that UHC after outpatient surgical fixation of DRFs is more common in patients undergoing treatment at a safety-net hospital versus those treated at a university-affiliated facility. Methods: An IRB-approved retrospective review studied patients who underwent outpatient surgical treatment of DRFs from January 2017 to May 2021. Surgery was performed either at a local safety-net hospital or at a university-affiliated hospital. UHC was defined as telephone calls, emergency room visits, and/or readmissions to the hospital within 30 days of surgery. Demographic factors, medical comorbidities, and injury and surgery details were analyzed. Results: In total, 442 patients met inclusion criteria. An estimated 257 patients (58.1%) were treated at a university-affiliated facility, whereas 185 patients (41.9%) had surgery at the safety-net hospital. The overall rate of UHC within thirty-days of surgery was 14.0%, with the most common reason being uncontrolled pain. Rates of UHC were higher at the safety-net hospital compared with those at a university-affiliated facility (26.5% versus 5.1%, P < 0.05). Conclusions: UHC was significantly greater for patients undergoing surgery in a safety-net hospital setting compared with those in a university setting. UHC after surgery is often related to inadequate postoperative pain control. Improved pain control and patient education may alleviate unnecessary healthcare contact.

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Section: Discussionmentioning

confidence: 99%

Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study

Menon,

Payne,

Woodard

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Focusing on these physiological similarities between the soft tissue microenvironment after surgery and CRPS, we applied a combination of steroid and mannitol treatment used for CRPS to reduce postoperative edema and pain. Steroids are a popular postoperative adjunct in facial and musculoskeletal operations due to the high tendency for edema development in the face and extremities [24][25][26][27][28]. Steroids inhibit the expression of proinflammatory cytokines and the production of inflammatory mediators such as prostaglandins [23].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, it is unknown how effective this combination is compared to the steroid-only treatment. Steroids are already widely used drugs in hand surgery [25,26]. We borrowed the regimen used in CRPS based on the common pathophysiology of hand edema and CRPS, but to more accurately determine the effect of combining mannitol, there should be a study directly comparing it with a group using only steroids.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Steroid and Mannitol Combination Treatment on Postoperative Rehabilitation of Multiple Metacarpal Bone Fractures

et al. 2023

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Background and Objectives: The expedient resolution of postoperative soft tissue edema is particularly important in hand surgery. Prolonged edema and pain become an obstacle to postoperative rehabilitation, delay return to daily life, and in severe cases, lead to a permanent decrease in range of motion. Based on the common physiology between postoperative hand swelling and complex regional pain syndrome (CRPS), we sought to determine if postoperative mannitol and steroid administration to multiple metacarpal bone fracture patients effectively reduces hand swelling and pain and is beneficial for hand rehabilitation. Materials and Methods: From March 2015 to February 2019, 21 patients who received closed pinning for multiple metacarpal fractures were included in a retrospective cohort study. The control group (n = 11) underwent a routine recovery, while the treatment group (n = 10) received dexamethasone and mannitol injections for five days postoperatively. Serial changes in the degree of pain and fingertip-to-palm distance (FPD) were measured in both groups. The duration from surgery to the initiation of rehabilitation and time to full grip was also compared. Results: Compared to the control, the treatment group showed a faster alleviation of pain scores from the postoperative fifth day (2.91 versus 1.80, p = 0.013), and faster recovery of FPD from postoperative two weeks (3.27 versus 1.90, p = 0.002). Time to physical therapy initiation (6.73 versus 3.80 days, p = 0.002) and full grip achievement (42.46 versus 32.70 days, p = 0.002) were also faster in the treatment group. Conclusions: The steroid-mannitol combination treatment for multiple metacarpal bone fracture patients in the acute postoperative phase promoted the reduction of hand edema and pain, leading to the earlier initiation of physical therapy, rapid improvement in joint motion, and faster achievement of full grip.

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“…Recently, Gottschalk et al reported a trial that randomized 58 patients to a 6-day oral methylprednisolone taper (MPT) after distal radial fracture open reduction and internal fixation compared with a control group (no MPT). They reported that, in the week after the distal radial fracture open reduction and internal fixation, patients in the MPT group had a substantial mean reduction in opioid use (7.8 ± 7.2 pills) compared with the control group (15.5 ± 11.5 pills), especially starting on postoperative day 2 53 . Corticosteroids in various forms appear to be helpful adjuvant therapy for postoperative pain management.…”

Section: Practice Managementmentioning

confidence: 99%

What’s New in Hand Surgery

Bohn

2024

Journal of Bone and Joint Surgery

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A Prospective Randomized Controlled Trial of Methylprednisolone for Postoperative Pain Management of Surgically Treated Distal Radius Fractures

Cited by 7 publications

References 55 publications

Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study

Unscheduled Healthcare Contact after Outpatient Surgical Fixation of Distal Radius Fractures: A Retrospective Cohort Study

The Effect of Steroid and Mannitol Combination Treatment on Postoperative Rehabilitation of Multiple Metacarpal Bone Fractures

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