Influence of Ibuprofen on Bone Healing After Colles' Fracture: A Randomized Controlled Clinical Trial

Abstract

Non‐steroidal anti‐inflammatory drugs (NSAIDs) may delay bone healing. [Therefore, it is important to establish whether NSAID preparations delay bone healing and what correlations, if any, exist between different bone studies—DEXA—scanning, bone markers, roentgenology controls, and histological examination of newly formed bone]. The purpose of this prospective controlled study was to investigate whether ibuprofen affects bone mineral density, turnover biomarkers, and histomorphometric characteristics of the callus after a Colles' fracture. This study was a single‐center, triple‐blinded, randomized clinical trial. Ninety‐five patients (80 females) with displaced Colles' fracture, median age 65 (range 40–85) years were included in the study and operated on by external fixation from June 2012 through to June 2015. Eighty‐nine patients received interventional medicine and 83 completed the 1‐year follow‐up. The 7‐day ibuprofen group received 600 mg of ibuprofen three times a day (N = 29), the 3‐day ibuprofen group received ibuprofen for 3 days (N = 30) and a placebo for the following 4 days, and finally, the placebo group received a placebo for 7 days (N = 30). The primary outcome was the difference in bone mineral density between the ultra‐distal region of the injured and non‐injured radius at 3 months after surgery. The histomorphometric outcomes included the assessment of callus tissue volume and surface fractions at 6 weeks postoperatively. The biomarkers Osteocalcin and CrossLaps were measured at baseline, 1 week, 2 weeks, 6 weeks, 3 months, and 1 year. We included the results of the dropped‐out patients in the intention to treat analysis. There was no difference between treatment groups in bone mineral density, histomorphometric estimations, and changes in bone biomarkers. These findings may offer an indication of ibuprofen as a bone‐safe analgesic treatment in an acute fracture‐phase. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:545–554, 2020

Do NSAIDs Really Interfere with Healing after Surgery?

“…In a recent small RCT ( n = 128) of open reduction and internal fixation of ankle fractures, ketorolac vs. no ketorolac had no effect on clinical or radiographic healing assessed by blinded observers at 12 weeks postoperatively [ 20 ]. A randomized controlled trial (RCT) in patients with Colles’ fracture ( n = 95) showed no difference in outcome between the groups receiving ibuprofen and placebo [ 21 ]. In another more recent multicenter observational study, NSAID use versus opioid use after intermedullary nailing of diaphyseal tibia fractures ( n = 372) had no effect on healing time [ 22 ].…”

Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)

“…С другой стороны, серия наблюдательных исследований, проведенных в последнее время, показала отсутствие негативного влияния НПВП на консолидацию переломов ЛК и костей голени [22][23][24][25]. По результатам метаанализа 13 исследований (3 клинических и 10 экспериментальных), проведенного К. Duchman и соавт.…”

Flunixin Meglumine Enhanced Bone Fracture Healing in Rabbits Associated with Activation of Early Collagen Deposition and Enhancement of Vascular Endothelial Growth Factor Expression

“…Furthermore, various reports have suggested that NSAIDs interfere with bone healing, though others have contradicted these findings [7]. Celecoxib [8,9] and aspirin [10] inhibit bone healing [11,12], while ibuprofen [13] and parecoxib [14] do not affect bone healing.…”