The influence of preoperative methylprednisolone bolus on edema in lower leg fractures: A prospective randomized controlled trial.

Introduction: Lower limb fractures are often associated with significant soft tissue damage, leading to edema and unfavorable conditions for wound healing. This study investigates the efficacy of a preoperative bolus of methylprednisolone (MP) in reducing edema and improving postoperative function in patients undergoing ankle or tibial fracture surgery.

Hypothesis: We hypothesized that the cohort receiving the steroid would experience faster edema reduction and improved functional outcomes.

Material and methods: A monocentric, prospective, randomized, double-blind, controlled trial was conducted from May 2019 to June 2023, including 104 patients. The experimental group (n = 51) received a 2 mg/kg bolus of MP in 100 ml of saline, while the control group (n = 51) received 100 ml of saline prior to surgery. Data were collected on the intervention day and postoperatively at days 2, 7, 15, 45, and at 3 and 6 months. Leg circumference ratio, pain intensity, wound healing, complications, LEFS scores, and work and sport resumption were recorded.

Results: There were no significant differences in edema reduction between the two groups, except on day 15, where the MP group showed a significantly lower leg circumference ratio compared to the placebo group (P = 0.015). No differences were found in pain scores, functional recovery, or return to work. Both groups had comparable complication rates, with no evidence of adverse effects associated with the steroid treatment.

Conclusion: The injection of a bolus of MP had a slight positive impact on lower leg edema without apparent risk of adverse event. The long-term monitoring (6 months) and the low rate of lost to follow-up let us affirm that a single 2 mg/kg MP bolus does not impede wound healing or functional recovery.

Level of evidence: II; prospective randomized controlled trial.