Myth - Ibuprofen and Non-union of Fractures

Short Attention Span Summary

Ibuprofen = non-union?
In 808 pediatric patients with fractures prone to malunion or non-union, 338 (42%) were exposed to ibuprofen.  Of the 808 total patients, 3% (27/808) had a bone healing complication of some kind; 3% (10/338) of the kids exposed to ibuprofen; 4% (17/470) of kids not exposed.  There was no statistical difference.  This was a retrospective study, but the definition of "exposure" to ibuprofen was easy to determine, which makes the results believable.  This is already routine practice for our pediatric orthopedic team.  They worry more about non-union with NSAID use in elderly smokers and diabetic patients.

Spoon Feed
The dogma is - no NSAIDs for fractures - because it increases the risk of bone healing complications, but this study challenges that.


Abstract

J Emerg Med. 2016 Oct 14. pii: S0736-4679(16)30802-2. doi: 10.1016/j.jemermed.2016.09.027. [Epub ahead of print]

Does the Use of Ibuprofen in Children with Extremity Fractures Increase their Risk for Bone Healing Complications?

DePeter KC1, Blumberg SM1, Dienstag Becker S2, Meltzer JA1.

Author information:

1Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.

2Albert Einstein College of Medicine, Bronx, New York.

Abstract

BACKGROUND:

Despite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing.

OBJECTIVE:

To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures.

METHODS:

We performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service. We chose these fractures due to their higher risk for complications. We classified patients as exposed if they received ibuprofen in the PED or during hospitalization or were prescribed ibuprofen at discharge. The main outcome was a bone healing complication as evidenced by nonunion, delayed union, or re-displacement on follow-up radiographs.

RESULTS:

Of the 808 patients included in the final analysis, 338 (42%) were exposed to ibuprofen. Overall, 27 (3%) patients had a bone healing complication; 8 (1%) developed nonunion, 3 (0.4%) developed delayed union, and 16 (2%) developed re-displacement. Ten (3%) patients who were exposed to ibuprofen, and 17 (4%) who were not, developed a bone healing complication (odds ratio 0.8, 95% confidence interval 0.4-1.8; p = 0.61). There was no significant association between ibuprofen exposure and the development of a bone healing complication despite adjustment for potential confounders.

CONCLUSION:

Children with extremity fractures who are exposed to ibuprofen do not seem to be at increased risk for clinically important bone healing complications.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27751698 [PubMed - as supplied by publisher]