title: Perioperative Glucocorticoid Administration Improves Elbow Motion in Terrible Triad Injuries.
abstract: OBJECTIVE
  Among patients who undergo surgical treatment of terrible triad elbow injuries (TTEI), we hypothesized that those who received perioperative glucocorticoid (GC) therapy would have improved postoperative pain and range of motion (ROM) and a similar complication rate compared with patients who did not receive GC therapy.
  
  
  METHODS
  We retrospectively identified 26 patients who underwent surgical treatment of TTEI from 2009 to 2015. Thirteen patients received a single intraoperative dose of 10 mg intravenous dexamethasone followed with a 6-day oral methylprednisolone taper course (GC group), and 13 did not (control group). After surgery, patients were placed in an orthosis at 90° flexion with the forearm in pronation for 2 weeks, after which ROM was initiated. Patients were seen in clinic at 2, 6, 12, and 24 weeks after surgery, at which time numeric pain scale scores and ROM data were collected and any complications were noted.
  
  
  RESULTS
  Compared with the control group, the GC group had a greater flexion-extension arc of motion at 24 weeks (132.5° vs 105.5°); significant differences were not found at earlier time points. Supination measurements were significantly greater for the GC group at every time point with a difference at final follow-up of 23.2° (61.0° vs. 84.2°). There were 5 complications in the control group (35.8%), 3 of which required additional surgery, and 3 complications in the GC group (23.1%), 1 of which required another surgery. No postoperative infections were found in either group.
  
  
  CONCLUSIONS
  Perioperative glucocorticoid administration is associated with improved ROM after surgical treatment of TTEI. Flexion-extension, pronosupination arc of motion, and overall supination were significantly improved. Postoperative pain scores and complication rates were similar between GC and control groups.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN. Electronic address: mihirjdesai@gmail.com.
authors.forename: Mihir J
authors.initials: MJ
authors.lastname: Desai
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Matson
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David S
authors.initials: DS
authors.lastname: Ruch
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Fraser J
authors.initials: FJ
authors.lastname: Leversedge
authors.affiliation: Triangle Orthopaedic Associates, Durham, NC.
authors.forename: J Mack
authors.initials: JM
authors.lastname: Aldridge
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Richard
mesh_terms: D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular / Q000187:drug effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D008775:Methylprednisolone
keywords: Terrible triad; elbow dislocation; elbow trauma; glucocorticoids; steroids