Abstract
This systematic review evaluates and synthesizes the available peer-reviewed evidence regarding the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing in skeletally immature patients. Evidence supports the use of NSAIDs in this patient population for adequate pain control without increasing the risk of nonunion, particularly in long bone fractures and pseudoarthrosis after spine fusion. However, further clinical studies are needed to fill remaining gaps in knowledge, specifically with respect to the spectrum of available NSAIDs, dosage, and duration of use, in order to make broad evidence-based recommendations regarding the optimal use of NSAIDs during bone healing in skeletally immature patients.
Highlights
Nonsteroidal anti-inflammatory drugs (NSAIDs) have consistently been some of the most widely used medications for decades, based on their anti-inflammatory and analgesic mechanisms of action, in conjunction with their safety profiles and non-addictive characteristics [1]
In addition to these contrasting results in skeletally mature population studies, evidence-based recommendations regarding the use of NSAIDs for pain management after fractures in the pediatric, skeletally immature population have not been conclusive to date
The meta-analysis studies were excluded from this analysis as the 4 retrospective pediatric studies, cited in this literature, are included in this current review
Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs) have consistently been some of the most widely used medications for decades, based on their anti-inflammatory and analgesic mechanisms of action, in conjunction with their safety profiles and non-addictive characteristics [1]. Several animal models and retrospective cohort studies have demonstrated the potential for NSAIDs to increase the risk of non-union in the skeletally mature population [6,9,10]. Recent prospective studies have shown that NSAIDs do not increase the risk of nonunion, while improving pain control with a potential opioid-sparing effect [11,12,13]. In addition to these contrasting results in skeletally mature population studies, evidence-based recommendations regarding the use of NSAIDs for pain management after fractures in the pediatric, skeletally immature population have not been conclusive to date
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