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Scientific Articles   |    
The Effect of Nonsteroidal Anti-Inflammatory Drug Administration on Acute Phase Fracture-Healing: A Review
Andrew P. Kurmis, BMBS, PhD1; Timothy P. Kurmis, BMBS2; Justin X. O’Brien, BMBS3; Tore Dalén, MD, PhD4
1 Department of Orthopaedics, Repatriation General Hospital, Daws Road, Daw Park 5041, South Australia, Australia. E-mail address: Andrew.Kurmis2@health.sa.gov.au
2 Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia
3 Taylor Laboratory, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville 3052, Victoria, Australia
4 Department of Orthopaedics, Umeå University Hospital, S-901 85 Umeå, Sweden
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  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopaedics, Repatriation General Hospital, Daw Park, South Australia, Australia,



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 02;94(9):815-823. doi: 10.2106/JBJS.J.01743
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Abstract

Background: 

The analgesic efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established, and these agents often form an integral part of posttraumatic pain management. However, potentially deleterious effects of resulting prostaglandin suppression on fracture-healing have been suggested.

Methods: 

A systematic literature review involving searches of electronic databases and online sources was performed to identify articles exploring the influence of NSAIDs on fracture-healing.

Results: 

A structured search approach identified 316 papers as potentially relevant to the topic, and these were manually reviewed. The majority described small-scale studies that were retrospective or observational in nature, with limited control of potentially confounding variables, or presented little key information that was not also present in other studies.

Conclusions: 

Although increasing evidence from animal studies suggests that cyclooxygenase-2 (COX-2) inhibition suppresses early fracture-healing, in vivo studies involving human subjects have not provided convincing evidence to substantiate this concern. We found no robust evidence to attest to a significant and appreciable patient detriment resulting from the short-term use of NSAIDs following a fracture. The balance of evidence in the available literature appears to suggest that a short-duration NSAID regimen is a safe and effective supplement to other modes of post-fracture pain control, without a significantly increased risk of sequelae related to disrupted healing.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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