Prophylactic corticosteroid injection in ulnar wrist pain in distal radius fracture

Abstract

Background:Ulnar sided wrist pain is one of the most common complications of distal radius fractures. The simplest method for decreasing pain for this affliction is corticosteroid injection. The present study was designed to assess the effect of corticosteroid injection in the prevention of ulnar sided wrist pain.Materials and Methods:In this clinical trial patients with distal radius fractures scheduled for closed reduction and percutaneous pin fixation were divided into control and corticosteroid groups. In the corticosteroid group, the patient received a single betamethasone injection in the dorsoulnar side of the wrist before reduction, while the control group received placebo. The patients were to be followed for at least 6 months.Results:82 patients were followed for 6 months. At the end of the 3 months followup the difference between the two groups about the number of individuals without ulnar sided wrist pain was statistically significant (P = 0.038), so that less patients in the control group were painless, while this was not the case in the 6 months followup (P = 0.507), but in the both time frames the mean grip power, visual analog pain score and the disabilities of the arm, shoulder and hand (DASH) score showed statistically significant difference between the two groups, so that the corticosteroid groups demonstrated greater power grip and less scores in pain and DASH (P < 0.05).Conclusion:Based on the findings of the present study it seems that prophylactic corticosteroid injection will be associated with a decrease in the severity of wrist pain in patients with acute distal radius fractures. With regard to the decrease in the number of painless individuals, it seems that the decrease is not persistent. Overall the need for a study with longer followup is obvious.

Effect of use of NSAIDs or steroids during the acute phase of pain on the incidence of chronic pain: a systematic review and meta-analysis of randomised trials

“…2 ). Two other small sample studies (Bogefeldt et al 2008 ; Saied et al 2015 ) of non-postoperative pain (n = 242) showed that steroids can reduce the incidence of chronic pain, but neither reported therapeutic doses (RR 0.72 [95% CI 0.54–0.96]; supplementary Fig. 3 ), results need to be interpreted with caution.…”

“…Of the 20 studies (3788 participants) involving nociceptive pain, 1 study evaluated both steroids and NSAIDs (in different group) (Romundstad et al 2006 ), 9 studies evaluated steroids (Turan et al 2015 ; Romundstad et al 2006 ; Bogefeldt et al 2008 ; Dojode 2012 ; Lin et al 2010 ; Spijker-Huiges et al 2014 ; Saied et al 2015 ; Mardani-Kivi et al 2015 ; Li et al 2018 ), and 12 studies evaluated NSAIDs (van Helmond et al 2016 ; Sun et al 2013 ; Romundstad et al 2006 ; Ling et al 2016 ; Fransen et al 2006 ; Comez et al 2015 ; Bugada et al 2015 ; Hancock et al 2007 ; Shin et al 2013 ; Wang et al 2014 ; Haddad et al 2019 ; Ge et al 2021 ).…”

“…Of the 9 studies involving steroids, 5 studies (1556 participants) reported the incidence of chronic pain (Turan et al 2015 ; Romundstad et al 2006 ; Bogefeldt et al 2008 ; Saied et al 2015 ; Li et al 2018 ). Moderate quality evidence supports that steroid use during the acute phase of pain does not reduce the incidence of chronic nociceptive pain compared with control (RR 0.94 [95% CI 0.85–1.04], P = 0.25, I 2 = 13%; Fig.…”

“…The steroids evaluated included 2 methylprednisolone (125 mg/250 mg iv., single dose) (Turan et al 2015 ; Romundstad et al 2006 ), 1 betamethasone (1 cc local injection, duration unknown) (Saied et al 2015 ), 1 dexamethasone (10 mg thoracic paravertebral block, single dose) (Li et al 2018 ), 1 no specific medications and dose were not reported (Bogefeldt et al 2008 ). No serious drug-related complications in the five studies.…”

“…Of the 9 studies involving steroids, 6 studies (358 participants) reported intensity of pain (Dojode 2012 ; Lin et al 2010 ; Spijker-Huiges et al 2014 ; Saied et al 2015 ; Mardani-Kivi et al 2015 ; Li et al 2018 ). Low quality evidence supported the use of steroids to reduce pain intensity in chronic nociceptive pain over the 6-month follow-up period (SMD − 0.46 [95% CI − 0.72 to − 0.19], P = 0.0007, I 2 = 67%; Fig.…”