Am Fam Physician. 2024;109(4):376-377
Author disclosure: No relevant financial relationships.
Key Points for Practice
• NSAIDs improve pain control and decrease opioid use in adults with traumatic fractures and should be used in most patients.
• NSAIDs may slightly increase the likelihood of nonunion.
• Opioid use after fracture also appears to increase the risk of nonunion.
• Intravenous ketorolac is beneficial in the acute care of adult patients with a traumatic fracture without increasing fracture nonunion.
From the AFP Editors
Opioids have been traditionally used for analgesia after orthopedic trauma because of concern that nonsteroidal anti-inflammatory drug (NSAID) use increases fracture nonunion. Because opioid misuse and abuse have risen to critical levels and opioid use has also been associated with fracture nonunion, the safety of NSAID use after orthopedic trauma is an open question. The Eastern Association for the Surgery of Trauma and the Orthopaedic Trauma Association conducted systematic reviews to publish guidelines for the use of NSAIDs after traumatic orthopedic fractures in adults with regard to acute pain control and risk of nonunion.
Risk of Nonunion
NSAIDs are recommended after fracture because the benefit of improved acute pain control outweighs the low risk of nonunion. Although NSAID use increased fracture non-union in more than 600,000 patients studied, the number needed to harm was 105 (95% CI, 47 to 1,173) compared with not using an NSAID. The risk might be slightly higher with chronic NSAID use before fracture, with indomethacin, and in patients with hip fracture.
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