Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 494-502
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.494
Effect of non-steroidal anti-inflammatory drugs on fracture healing in children: A systematic review
Sarah Stroud, Toshali Katyal, Alex L Gornitzky, Ishaan Swarup
Sarah Stroud, Alex L Gornitzky, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94143, United States
Toshali Katyal, Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children’s Hospital, San Francisco, CA 94143, United States
Ishaan Swarup, Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children’s Hospital Oakland, Oakland, CA 94609, United States
Author contributions: Katyal T performed the literature search for the systematic review; Stroud S and Katyal T reviewed the articles using the inclusion and exclusion criteria; Stroud S, Katyal T, and Gornitzky AL collected and analyzed the data and wrote the paper; Swarup I supervised and contributed to the report.
Conflict-of-interest statement: The authors have no conflicts to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ishaan Swarup, MD, Assistant Professor, Department of Orthopaedic Surgery, University of California, San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Oakland, CA 94609, United States. ishaan.swarup@ucsf.edu
Received: March 3, 2021
Peer-review started: March 3, 2021
First decision: July 28, 2021
Revised: September 14, 2021
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: May 18, 2022
Processing time: 435 Days and 12.2 Hours
ARTICLE HIGHLIGHTS
Research background

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications in the United States. Although they are safe and effective means of analgesia for children with broken bones, there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.

Research motivation

The goal of this systematic review was to assess whether NSAID exposure is a risk factor for fracture nonunion in children.

Research objectives

The goal of this systematic review was to assess whether NSAID exposure is a risk factor for fracture nonunion in children.

Research methods

We systematically reviewed the literature reporting the effect of NSAIDs on bone healing. We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure. The outcomes of interest were delayed union or nonunion. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. A final table was constructed summarizing the available evidence.

Research results

A total of 120 articles were identified and screened, of which 6 articles were included for final review. Nonunion in children is extremely rare; among the studies included, there were 2011 nonunions among 238822 fractures (0.84%). None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period. Additionally, children are likely to take these medications for only a few days after injury or surgery, further decreasing their risk of adverse side-effects.

Research conclusions

This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing. Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.

Research perspectives

Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.