Population: Adults (18 years and older) inpatient or outpatients with a diagnosis of certain long bone fractures (neck of femur/tibia/fibula/tibia and fibula/radius/ulna/humerus/clavicle) based on ICD-9 codes.There have been multiple studies investigating this issue with mixed results.Ĭlinical Question: Is there increased risk for fracture non-union with certain classes of NSAIDs? Non-selective NSAIDs block cyclooxygenase (COX)-1 and 2 while selective NSAIDs only inhibit COX-2. One class of medication that has been implicated in negatively impacting bone healing is NSAIDs. The top risk factors for non-union according to a study by Santolini et al were open method of fracture reduction, open fracture, presence of post-surgical fracture gap, smoking, infection, wedge or comminuted types of fracture, high degree of initial fracture displacement, lack of adequate mechanical stability provided by the implant used, fracture location in the poor zone of vascularity of the affected bone, and a fractured tibia. These factors include: Use of tobacco products, older age, severe anemia, alcohol intake, diabetes, low vitamin D levels, hypothyroidism, poor nutrition, infection, open fracture and certain medications (ex.
Several risk factors have been associated with increased risk of delayed or non-union. Non-union is defined as “a failure of the fracture-healing process” and occurs in up to 1 in 10 fractures. Sometimes the healing process can take longer than usual (delayed union), does not heal (non-union) or in poor alignment (malunion). When bones break, they usually heal with either surgical or non-surgical management. It remains a controversial topic in the orthopaedic specialty. She currently takes thyroid replacement therapy and has no known drug allergies.īackground: There are conflicting studies about fracture healing and the use of non-steroidal anti-inflammatories (NSAIDs) in humans. Upon discharge she asks what she should take for pain because she read somewhere that anti-inflammatory drugs like ibuprofen can prevent bone healing. You immobilize her in a below elbow splint which provides significant pain relief and refer her to the local orthopedic fracture clinic. The X-ray demonstrates a fracture of the distal radius that is in an acceptable position and does not require a reduction. 2020Ĭase: A healthy 55-year-old woman was out for a walk and had a FOOSH (fall on outstretched hand) of her dominant arm. Risk of Nonunion with Nonselective NSAIDs, COX-2 Inhibitors, and Opioids. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) working at the Fowler Clinic and the Roth McFarlane Hand and Upper Limb Centre. He served with the Canadian Forces as a Medical Officer and Flight Surgeon. Steve completed his Sport Medicine fellowship training with the Fowler Kennedy Sport Medicine Clinic in 2017.
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