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The Effect of Nonsteroidal Anti-Inflammatory Drug Administration on Acute Phase Fracture-Healing: A Review

Kurmis, Andrew P. BMBS, PhD; Kurmis, Timothy P. BMBS; O’Brien, Justin X. BMBS; Dalén, Tore MD, PhD

Journal of Bone & Joint Surgery - American Volume: 2 May 2012 - Volume 94 - Issue 9 - p 815–823
doi: 10.2106/JBJS.J.01743
Scientific Articles

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.

1Department of Orthopaedics, Repatriation General Hospital, Daws Road, Daw Park 5041, South Australia, Australia. E-mail address:

2Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia

3Taylor Laboratory, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville 3052, Victoria, Australia

4Department of Orthopaedics, Umeå University Hospital, S-901 85 Umeå, Sweden

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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