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Do non-steroidal anti-inflammatory drugs cause a delay in fracture healing?
  1. Simon Clarke, Consultant,
  2. Fiona Lecky, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; s.carley1btinternet.com

    Abstract

    A short cut review was carried out to establish whether there is any evidence that non-steroidal anti-inflammatory drugs (NSAIDs) might delay fracture healing. A total of 514 papers were found using the reported search, of which three represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. At present, although there are theoretical concerns about the adverse effects of NSAIDs on fracture healing, there is not enough clinical evidence to deny patients with simple fractures their analgesic benefits.

    • NSAIDs
    • fracture

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    Report by Simon Clarke, ConsultantChecked by Fiona Lecky, Consultant

    Clinical scenario

    A 21 year old man attends the emergency department having sustained an undisplaced, closed fracture of his distal radius. You wonder whether giving the patient a course of NSAIDs will delay fracture healing.

    Three part question

    In [patients with simple fractures] do [NSAIDs compared with conventional analgesia] delay [fracture healing]?

    Search strategy

    Medline 1966–04/05 using the OVID interface. [(exp fractures OR fracture$.mp OR fracture healing.mp) AND (exp anti-inflammatory agents, non-steroidal OR nsaid$.mp OR anti-inflammatory$.mp)] LIMIT to human. References of papers and suitable review articles were scrutinised for further possible articles.

    Search outcome

    A total of 514 papers were found of which three were relevant to the three part question. No further articles were discovered by the reference review.

    Comment(s)

    Inflammatory processes are integral to the early stages of fracture healing and there is theoretical concern that this may be inhibited by NSAIDs leading to delayed or even non-union. This worry seems to have been backed up by animal experimentation (primarily on rats); the two small randomised controlled trials did not give any clear evidence to suggest that this is translated into significant clinically adverse effects in humans. The case control study has raised a concern about the relation of NSAIDs to non-union that needs further evaluation. NSAIDs are effective analgesics for musculoskeletal trauma, so until more solid evidence becomes available, their use should not be discouraged.

    CLINICAL BOTTOM LINE

    At present, although there are theoretical concerns about the adverse effects of NSAIDs on fracture healing, there is not enough clinical evidence to deny patients with simple fractures their analgesic benefits.

    Table 1

    Report by Simon Clarke, ConsultantChecked by Fiona Lecky, Consultant

    References

    1. 2.
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