Fracture healing and NSAIDs.

Evidence • Adults—2 RCTs (N = 140) of predominantly middle-aged women with Colles fractures randomized to flurbiprofen (14 days)1 or piroxicam (20 mg/d for 8 weeks)2 versus placebo: -No difference in recovery time, physiotherapy needs, malunion or nonunion,1 functional recovery, or healing.2 -Superior pain relief with NSAIDs (both trial arms allowed acetaminophen if required). -Limitations: about 20% lost to follow-up; small numbers. • Children—1 RCT (N = 336)3 of children with arm fractures randomized to ibuprofen or acetaminophen and codeine: -No difference in fracture nonunion at 1 year. -Ibuprofen provided equivalent pain relief with less functional impairment and fewer adverse effects. • Quasi-RCT of adults with acetabular fractures requiring heterotopic ossification prophylaxis4 is misleading. Patients with less-serious injuries and different surgical approach (not randomized to NSAIDs or radiation for prophylaxis) were analyzed in the “non-NSAID” arm.