The Effect of Postoperative Nonsteroidal Anti-inflammatory Drugs on Nonunion Rates in Long Bone Fractures

• Published in: Orthopedics (Thorofare, N.J.) Vol. 43; no. 4; pp. 221 - 227
• Main Authors: Tucker, William A, Birt, Mitchell C, Heddings, Archie A, Horton, Greg A
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.07.2020; SLACK INCORPORATED
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Care and treatment; Comorbidity; Complications and side effects; Cost analysis; Databases, Factual; Diabetes; Female; Femoral Fractures - surgery; Fracture Healing - drug effects; Fractures; Fractures, Ununited - chemically induced; Fractures, Ununited - epidemiology; Health risk assessment; Humans; Humeral Fractures - surgery; Kidney diseases; Male; Middle Aged; Multivariate analysis; Nonsteroidal anti-inflammatory drugs; Open fractures; Pain, Postoperative - drug therapy; Patient outcomes; Patients; Postoperative Care - adverse effects; Postoperative Care - methods; Retrospective Studies; Risk Factors; Software; Studies; Tibial Fractures - surgery; Treatment Outcome; United States; Colorado
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20200428-06

The association of nonsteroidal anti-inflammatory drugs (NSAIDs) with non-union in long bone fractures has been controversial. The purpose of this study was to evaluate whether NSAID exposure results in increased risk of non-union in operatively treated long bone fractures. The authors used International Classification of Diseases and Current Procedural Terminology codes to identify patients under a single-payer private insurance with operatively treated humeral shaft, tibial shaft, and subtrochanteric femur fractures from a large database. Patients were divided into cohorts based on NSAID use in the immediate postoperative period, and nonunion rates were compared. A cost analysis and a multivariate analysis were performed. Between 2007 and 2016, a total of 5310 tibial shaft, 3947 humeral shaft, and 8432 subtrochanteric femur fractures underwent operative fixation. Patients used NSAIDs in the first 90 days postoperatively in 900 tibial shaft, 694 humeral shaft, and 967 subtrochanteric femur fractures. In these patients, nonunion rates were 18.8%, 17.4%, and 10.4%, respectively. When no NSAIDs were used, the rates were 11.4%, 10.1%, and 4.6% for each fracture type, respectively (P<.05). Among patients taking NSAIDs, subtrochanteric femur fractures had a 2.4 times higher risk of nonunion and humeral shaft and tibial shaft fractures both had a 1.7 times higher risk of nonunion (P<.05). Multivariate analysis showed NSAID use to be an independent risk factor in all 3 types. Cost analysis showed a great increase in economic burden (P<.05). This study indicated that NSAID exposure was associated with fracture nonunion. [Orthopedics. 2020;43(4):221-227.].