Tibia fractures and NSAIDs. Does it make a difference? A multicenter retrospective study

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Pharmacology

Background:

• Post-operative pain management following diaphyseal tibia fractures is crucial for patient recovery.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid medications are common analgesics, but their comparative effects on fracture healing remain debated.
• Cultural differences in pain management approaches can influence medication choices.

Purpose of the Study:

• To compare the healing time of diaphyseal tibia fractures (OTA/AO 42 A, B, C) treated with intramedullary nailing (IMN).
• To evaluate the impact of post-operative pain control using NSAIDs versus opioid medications on fracture healing duration.
• To investigate whether differing geographic and cultural pain management practices affect tibia fracture union rates.

Main Methods:

• Retrospective screening of tibia fractures (OTA/AO 42 A, B, C) treated with IMN at two level I trauma centers in different countries (2010-2017).
• Inclusion criteria: radiographic follow-up to union. Cohorts were divided based on post-discharge analgesic prescription: NSAIDs (n=190) or opioids (n=182).
• Fracture union defined as cortical bridging on AP and lateral radiographs; primary outcome was healing time.

Main Results:

• No statistically significant difference in fracture healing time between the NSAID (180.5 days) and opioid (185 days) groups (p=0.64).
• Opioid cohort had higher rates of tobacco use, diabetes mellitus, and polytrauma; NSAID cohort had more open fractures.
• Mean age was similar between groups.

Conclusions:

• NSAID use in the acute phase of tibia fracture healing did not significantly increase the risk of delayed union or nonunion.
• The study suggests NSAIDs can be used safely and effectively for pain management in tibia fracture patients.
• Further prospective randomized studies are recommended to definitively rule out any negative effects of NSAIDs on bone healing.