Abstract
AbstractThere is currently a lack of clear evidence on the impact of non‐steroidal anti‐inflammatory drugs (NSAIDs) on fracture healing post‐operatively. Australian orthopaedic surgeons were surveyed about their perceptions of the relationship between NSAIDs and fracture healing to determine whether equipoise exists within the profession. Results demonstrated divergence of opinion amongst Australian orthopaedic surgeons, lending support to the commencement of randomised controlled trials testing the influence of NSAIDs on fracture healing within Australia.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed following musculoskeletal injuries and fractures
The survey was developed by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) Steering Committee, after a literature review on NSAIDs and fracture healing
Over one-third of respondents (37.1%) agreed or strongly agreed that NSAIDs are associated with delayed union but fewer (23.8%) agreed or strongly agreed that NSAIDs are associated with non-union
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed following musculoskeletal injuries and fractures. The most recent high-quality systematic review on the association between NSAID use and fracture non-union concluded that, owing to a lack of clear evidence for impaired bone healing due to NSAID use, randomised controlled trials (RCTs) and high-quality prospective cohort studies are still needed.[1] Since this review was published in 2010, there has been no further progress within the field and the need for human studies persists. While RCTs can provide a higher level of evidence than observational studies, they can only be undertaken where clinical equipoise exists, i.e. genuine uncertainty within the medical community as to the effect of an intervention.[4] Equipoise would provide the ethical basis for an RCT, enabling randomisation of NSAID provision following orthopaedic surgical intervention. A lack of equipoise would indicate that RCTs on this topic may not be feasible and that only observational studies are possible within the chosen setting
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