Effect of Intravenous Methylprednisolone Versus NSAIDs on Early Soft Tissue Recovery in High-Energy Pilon and Foot Fractures: A Prospective Cohort Study

Background High-energy fractures of the tibial pilon, hindfoot, and midfoot are frequently associated with severe soft tissue injury, delaying definitive fixation. The “wrinkle sign” is a clinical marker of edema resolution and readiness for surgery. Corticosteroids may accelerate soft tissue recovery, but their role in orthopaedic trauma remains underexplored. We hypothesized that intravenous methylprednisolone would reduce the time to wrinkle sign appearance compared with intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with these types of fractures. Methods This prospective, multicenter cohort study included 40 patients treated at 2 hospitals between June 2022 and September 2024. Patients received either intravenous methylprednisolone (1 mg/kg/day, tapered every 3 days) or dexketoprofen (50 mg every 8 hours) starting at admission and based on the routine clinical practice of each hospital (treatment allocation was not randomized). The primary outcome was time to wrinkle sign appearance, and secondary outcomes included hospital length of stay and the incidence of soft tissue and infectious complications. Results The median time to wrinkle sign was shorter in the corticosteroid group (CG) (4.5 days [interquartile range, IQR = 3.5-8.0]) than in the NSAID group (NG) (7.5 days [IQR = 3.5-8.0]), though not statistically significant ( P = .192). However, patients receiving corticosteroids were significantly more likely to develop the wrinkle sign within 10 days (65% vs 30%; odds ratio = 4.33, 95% CI: 1.15-16.32; P = .03). No surgical site infections occurred in the CG, while 2 superficial infections were reported in the NG. Median hospital stay was shorter in the CG (11.5 vs 17.5 days), though not statistically significant ( P = .277). Conclusions In our sample, intravenous methylprednisolone was associated with a higher probability of achieving surgical readiness within 10 days in high-energy tibial pilon, hindfoot, and midfoot fractures, while maintaining a comparable safety profile. Level of Evidence: Level II