Dagher Tanios, Vatti Lohith, Sosa Diana, Strelzow Jason
University of Chicago Pritzker School of Medicine, 924 E 57th St, Chicago, IL, 60637, USA.
Lenox Hill Hospital, Northwell Health, 100 E 77th St, New York, NY, 10075, USA.
J Clin Orthop Trauma. 2025 May 20;67:103067. doi: 10.1016/j.jcot.2025.103067. eCollection 2025 Aug.
Corticosteroids are frequently administered perioperatively during arthroplasty procedures with reported reductions in length of stay (LOS), postoperative pain & nausea, and opioid consumption. This investigation aims to evaluate the effects of perioperative dexamethasone on LOS, post-operative outcomes, and adverse event rates for trauma patients undergoing femoral/tibial intramedullary nailing (IMN).
A retrospective cohort study was conducted at an urban Level 1 Trauma center between May 2018 and May 2022. 201 patients aged 16-65 with isolated femur or tibia fractures treated with antegrade or retrograde femoral or tibial IMN underwent chart review. Those with mental or physical disability, GFR <30, liver disease, poorly controlled diabetes (HbA1C ≥ 8), or steroid use within 3 months were excluded. Patients with both open and closed fractures were included in the study. LOS postoperatively was compared between patients who received dexamethasone perioperatively (Dex, n = 88) and those who did not (No Dex, n = 113). Secondary outcomes pertained to inpatient admission (e.g. average pain score), time to union, incidence of nonunion by 6 months, and 90-day surgical site infection rate. Categorical outcomes were analyzed using Wilcoxon rank-sum analysis and dichotomous data using chi-square testing.
There was no difference in LOS between groups (Dex 2.0 ± 1.6 days, No Dex 2.1 ± 1.3 days). While the Dex group had lower rates of superficial infection (Dex 0 % [0/43], No Dex 13.5 % [5/37]), opioid consumption (morphine milligram equivalent [MME]) on postoperative day 0 (Dex 16.7 ± 16.1, No Dex 21.1 ± 17.4), and MME POD0-3 average (Dex 24.5 ± 16.5, No Dex 30.5 ± 18.3), these results were not statistically significant. There were no differences in other secondary outcomes, including time to union, pain scores, average blood glucose, and complication rates.
Despite previous literature supporting a reduction in LOS associated with perioperative dexamethasone administration, the current study demonstrated no difference in trauma patients undergoing tibial or femoral IMN. However, perioperative administration may provide short-term benefits without increasing adverse event rate.
在关节置换手术围手术期经常使用皮质类固醇，据报道可缩短住院时间（LOS）、减轻术后疼痛和恶心，并减少阿片类药物的使用量。本研究旨在评估围手术期地塞米松对接受股骨/胫骨髓内钉固定术（IMN）的创伤患者的住院时间、术后结局和不良事件发生率的影响。
在一家城市一级创伤中心于2018年5月至2022年5月进行了一项回顾性队列研究。对201例年龄在16 - 65岁、因孤立性股骨或胫骨骨折接受顺行或逆行股骨或胫骨IMN治疗的患者进行病历审查。排除患有精神或身体残疾、肾小球滤过率（GFR）<30、肝病、糖尿病控制不佳（糖化血红蛋白[HbA1C]≥8）或在3个月内使用过类固醇的患者。开放性和闭合性骨折患者均纳入研究。比较围手术期接受地塞米松治疗的患者（地塞米松组，n = 88）和未接受治疗的患者（无地塞米松组，n = 113）术后的住院时间。次要结局包括住院情况（如平均疼痛评分）、骨折愈合时间、6个月时骨不连发生率和90天手术部位感染率。分类结局采用Wilcoxon秩和分析，二分数据采用卡方检验。
两组之间的住院时间无差异（地塞米松组2.0±1.6天，无地塞米松组2.1±1.3天）。虽然地塞米松组的浅表感染率较低（地塞米松组0%[0/43]，无地塞米松组13.5%[5/37]），术后第0天的阿片类药物使用量（吗啡毫克当量[MME]）较低（地塞米松组16.7±16.1，无地塞米松组21.1±17.4），以及术后第0 - 3天MME的平均使用量较低（地塞米松组24.5±16.5，无地塞米松组30.5±18.3），但这些结果无统计学意义。在其他次要结局方面无差异，包括骨折愈合时间、疼痛评分、平均血糖和并发症发生率。
尽管先前的文献支持围手术期使用地塞米松可缩短住院时间，但本研究表明，接受胫骨或股骨IMN的创伤患者之间无差异。然而围手术期使用可能在不增加不良事件发生率的情况下提供短期益处。
