The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures

Abstract

Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤ P ≤.9). During the first 3 days, the pain score was lower ( P =.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [ Orthopedics . 2021;44(2):105–110.]

Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association

“…Aliuskevicius et al 3 randomized patients with Colles’ fractures who did not undergo surgery to receive placebo, ibuprofen (3 days) or ibuprofen (7 days). The ibuprofen groups had significantly less pain in the first 7 days after fracture but no difference after 7 days.…”

“…Unfortunately, numerous attempts to study and quantify the relationship have led to conflicting results. 3–23 Furthermore, alternative treatments to NSAIDs, including opioids, have demonstrated similar associations to non-union. 18 A number of meta-analyses and systematic reviews have been performed in the non-trauma population with mixed results.…”

“…Traditionally, the most concerning adverse event related to NSAID use after orthopedic trauma is fracture non-union. Unfortunately, numerous attempts to study and quantify the relationship have led to conflicting results 3–23. Furthermore, alternative treatments to NSAIDs, including opioids, have demonstrated similar associations to non-union 18.…”

Opioid-Sparing Nonsteroid Anti-inflammatory Drugs Protocol in Patients Undergoing Intramedullary Nailing of Tibial Shaft Fractures: A Randomized Control Trial

“…Although there is a lack of literature assessing opioidsparing protocols for pain management long bone fractures in adults, numerous studies provide results that challenge the harmful effects of NSAIDs on bone healing. 7,8,[35][36][37][38][39] We acknowledge some limitations in our study. First, although both groups were a representative sample of the patients included, the control group showed a statistically significantly higher age than the experimental group.…”

The Influence of Ibuprofen on the Healing of Colles’ Fracture

“…Subsequently, the experience was that the ANOVA test was more applicable as it handles more than two samples and compares the variation within treatment groups to variation between treatment groups. Therefore, this test was applied in two of our publications; "Influence of ibuprofen on bone healing after Colles' fracture -a randomized controlled clinical trial" (2) and "The Influence of Ibuprofen on the Healing of Nonsurgically treated Colles' Fractures" (3).…”