Ibuprofen does not hinder bone fracture healing in children

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Contradicting previous beliefs, a US study found that ibuprofen is an effective medication for fracture pain in children and its use does not affect fracture healing.

Doctors have traditionally avoided prescribing non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen to patients with fractures. This belief is based on basic science research that supports delayed bone healing in some animal models, as well as in some spinal fusion cases.

However, a study from the University of Missouri School of Medicine and MU Health Care shows ibuprofen is an effective medication for fracture pain in children and its use does not affect fracture healing.

The study examined 95 skeletally immature children with fractures. Forty-six patients in the control group received acetaminophen for pain, while 49 patients in the NSAID group received ibuprofen. Six weeks after surgery, 82% of the control group and 92% of the ibuprofen group had healed fractures. At 10-to-12-week follow-ups, 98% of the control group and 100% of the ibuprofen group had healed.

"The findings of this study are relevant for a wide variety of practitioners," said study co-author Dr Sumit Gupta, 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 three 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," Gupta said. "Patients respond better to having two medications at the same time. So if that second medication can be ibuprofen instead of a narcotic, that's a much safer alternative."

Gupta believes the results from this study warrant further investigation to examine the effectiveness of other NSAID drugs besides ibuprofen, how NSAIDs work on specific types and locations of fractures and the effectiveness of this treatment on specific patient profiles, including adults.

Abstract
Background: This study aimed to investigate if nonsteroidal anti-inflammatory drugs (NSAIDs) used in the acute phase of bone healing in children with fractures result in delayed union or non-union as compared with patients who do not take NSAIDs for pain control during this same time period.
Methods: In this prospective, randomized, parallel, single-blinded study, skeletally immature patients with long bone fractures were randomized to 1 of 2 groups for their post-fracture pain management. The NSAID group was prescribed weight-based ibuprofen, whereas the control group was not allowed any NSAID medication and instead prescribed weight-based acetaminophen. Both groups were allowed to use oxycodone for breakthrough pain. The primary outcome was fracture healing assessed at 2, 6, and 10 weeks.
Results: One-hundred-two patients were enrolled between February 6, 2014 and September 23, 2016. Ninety-five patients (with 97 fractures) completed a 6-month follow-up (46 patients with 47 fractures in the control group and 49 patients 50 fractures in the NSAID group). None achieved healing at 1 to 2 weeks. By 6 weeks, 37 of 45 patients (82%) of control group and 46 out of 50 patients (92%) of ibuprofen group had healed fractures (P=0.22). At 10 to 12 week follow-up, 46 (98%) of the control group fractures were healed and 50 (100%) of the ibuprofen group fractures were healed. All were healed by 6 months. Healing was documented at a mean of 40 days in the control group and 31 days in the ibuprofen group (P=0.76). The mean number of days breakthrough oxycodone was used was 2.4 days in the control group and 1.9 days in the NSAID group (P=0.48).
Conclusion: Ibuprofen is an effective medication for fracture pain in children and its use does not impair clinical or radiographic long bone fracture healing in skeletally immature patients.

Authors
Julia AV Nuelle, Kelsie M Coe, Harvey A Oliver, James L Cook, Daniel G Hoernschemeyer, Sumit K Gupta

 

University of Missouri-Columbia material

 

Journal of Pediatric Orthopedics abstract

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