Steroid Administration for Articular Fractures of the Elbow (SAFE Trial) (SAFE)

  • STATUS
    Recruiting
  • End date
    Apr 1, 2025
  • participants needed
    144
  • sponsor
    Vanderbilt University Medical Center
Updated on 10 August 2022

Summary

The primary purpose of this study is to determine if perioperative glucocorticoid administration (IV intra-operative followed by a post-operative oral taper course) improves post-operative range of motion in a patient population that has sustained an intra-articular elbow fracture(s) (radial head, proximal ulna, distal humerus, or combined) that required operative fixation.

Description

Elbow fractures are complex injuries that often involve the articular surface, are in close proximity to critical neurovascular structures, and are prone to post-operative complications. Complications following treatment of intra-articular elbow pathology can affect over 50% of patients and up to 30% of all patients will require a re-operation. One of the most common complications is joint stiffness.1 When a flexion arc of motion is diminished to less than 100 degrees, a flexion contracture is present greater than 30 degrees, or forearm rotation is less than 100 degrees, functional limitations are frequently present and further treatment may be recommended.2,3 In fact, contracture release may be required in 12-20% of patients after intra-articular elbow fractures and carries a relatively high complication rate when performed.

The relationship of post-traumatic elbow contracture to intra-articular fractures is well established and can caused by extrinsic factors such as heterotopic ossification (HO), fibrosis and capsular thickening, or by intrinsic factors such as failure of nonunion, malunion, arthrosis, or loose bodies.2,4 Recent studies analyzing the acute phase synovial fluid cytokine profile after an intra-articular elbow fracture have shown proinflammatory and catabolic factors in high concentrations that can lead to contracture through myofibroblast differentiation and proliferation.4 Furthermore, HO can limit range of motion in up to 40% of fractures and may also result from prolonged inflammation with elevated IL-1β and TNF-α levels.

The purpose of this study is to determine if perioperative glucocorticoid administration (IV intra-operative followed by a post-operative oral taper course) improves post-operative range of motion in a patient population that has sustained an intra-articular elbow fracture(s) (radial head, proximal ulna, distal humerus, or combined) that required operative fixation.

Primary Study Questions

  1. For adult patients (>18yo) who sustain intra-articular elbow fractures (radial head, proximal ulna, distal humerus, or combined) that undergo operative fixation, does perioperative glucocorticoid administration (IV intra-operative followed by a post-operative oral taper course) improve post-operative range of motion (flexion/extension and pronation/supination) compared to a placebo?

Secondary Study Questions

2. Is perioperative glucocorticoid administration more effective in improving range of motion for certain intra-operative elbow fractures or depending on the mechanism of injury (subgroup comparison based on fracture type and high-energy or low-energy injuries)?

3. Do patients that receive perioperative glucocorticoids have a higher surgical site infection rate?

Details
Condition Elbow Fracture
Treatment Saline, Glucocorticoids
Clinical Study IdentifierNCT04738318
SponsorVanderbilt University Medical Center
Last Modified on10 August 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

• All adults ≥18 years old with an isolated, intra-articular traumatic elbow fracture to be
treated at Vanderbilt University Medical Center with operative intervention and a
standardized post-operative rehab protocol
Intra-articular elbow fracture defined as
Distal humerus
Proximal ulna
Radial head fracture
Combination fracture of two or more of the above
Radiographs present confirming intra-articular injury

Exclusion Criteria

Patients with bilateral elbow fractures
Patients with an altered mental status
Pregnant
Allergy or contra-indication to glucocorticoid administration
Type 1 or Type 2 diabetes
Pre-injury limitation in elbow range or motion (patient reported)
Unable to provide consent for themselves
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