Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are rarely, if ever, prescribed for patients with fractures: Delayed bone healing has been reported in some animal models of fractures and in some spinal fusion cases when the study subjects were given ibuprofen.
That may be changing, at least for pediatric patients: A new study from the University of Missouri School of Medicine and MU Health Care shows that ibuprofen is an effective medication for fracture pain in pediatric patients and does not affect fracture healing.
The prospective, randomized, parallel, single-blinded study included 95 skeletally immature pediatric patients with long bone fractures. The control group (n=46) received acetaminophen for pain, while patients in the NSAID group (n=49) received ibuprofen. Six weeks after surgery, 82% of the control group and 92% of the ibuprofen group had healed fractures. At the 10- to 12-week follow-up visit, 98% of the control group and 100% of the ibuprofen group had healed fractures.
“The findings of this study are relevant for a wide variety of practitioners,” said study co-author Sumit Gupta, MD, an associate professor of orthopaedic surgery at the MU School of Medicine.
“I think this study will be especially important when the patient first presents to the emergency department. The physician there should feel comfortable prescribing ibuprofen in addition to acetaminophen as a safe and effective pain reliever that won’t hinder a child’s bone healing.”
Patients in the control and ibuprofen groups reported similar pain management scores during the first 3 days after injury and at each follow-up interval. For the control group, acetaminophen was used for 3.9 days on average, while the ibuprofen group average was 4.3 days.
“We often find that pain management is not adequate with just acetaminophen,” Dr. Gupta said. “Patients respond better to having 2 medications at the same time. So, if that second medication can be ibuprofen instead of a narcotic, that’s a much safer alternative.”
Dr. Gupta believes the results from this study warrant further investigation to examine the effectiveness of NSAIDs other than ibuprofen; how NSAIDs work on specific types and locations of fractures; and the effectiveness of this treatment on specific patient profiles, including adults.
Nuelle JAV, Coe KM, Oliver HA, Cook JL, Hoernschemeyer DG, Gupta SK. Effect of NSAID use on bone healing in pediatric fractures: a preliminary, prospective, randomized, blinded study. J Pediatr Orthop. 2020 Jun 16. doi: 10.1097/BPO.0000000000001603. Online ahead of print.