Do NSAIDs Inpair Fracture Healing?

Do NSAIDs Impair Fracture Healing?

There has been a theory that comes from looking at animal studies that NSAIDs like ibuprofen or Naproxen inhibit bone healing and may cause delayed unions or non-unions in fracture patients. Some doctors even go so far to say that you shouldn’t use NSAIDs in postoperative orthopedic case; but what is the truth?

A recent article in the Journal of Family Practice by Yates, Shah and Blackwell, showed NO, ALTHOUGH THE EVIDENCE VARIES. Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t appear to impair clinical fracture healing. Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

Evidence summaryNSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their antiprostaglandin properties delay callus formation and subsequent healing.1 However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results.

BOTTOM LINE
The majority of physicians agree and recommend using NSAIDs temporarily along with other measures—such as rest, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free.

For more info on this retrospective analysis, click here.

Can I Run on a Stress Fracture?

Lots of good questions in my Grapevine, Texas office and on the website this week. It is definitely marathon time of year! Lots of aching feet and legs from erratic training and “too much, too soon, too fast syndrome”.My favorite is “I have XYZ Marathon in a few weeks, Can I run on a stress fracture?” This was actually asked three times in two days by a patient and once in an inquiring email on www.myrundoc.com

Of course, my answer was, “Really?.....” Ok, so you think you are a tough guy and can run through a stress fracture, but this is a very bad idea!

1. Hurts like hell!



2. Probably break it into many more pieces



3. Probably end up not running for months



4. May end up on my operating room table for pins, plates and/or screws!



5. Are you really that stupid???

Seriously? A stress fracture is a small crack in the bone that hasn’t fractured all the way through. Guess what happens when you run on it? It breaks all the way through!

So, if you are running in the Olympic marathon and think you are amazingly tough, then try it; but bottom line: NO! You can’t run on a stress fracture! If you try, you probably won’t be running for quite some time after that race, so it better be worth it!

Learning point: If you even think you may have a stress fracture, an x-ray is indicated pronto! Remember that they often do not show up on plain films for up to two weeks after the injury. The tip of my index finger is usually right! Give us a call and we can squeeze you in. The best part of having 5 doctors at Foot & Ankle Associates of North Texas in Grapevine, is that we can always find an emergency spot with one of our doctors!

Denna Kastor Talks About Taking a Break After Breaking Her Foot at the Olympics

There was a good Q & A in Running Times talking to Deena Kastor about her foot fracture at the Olympics. I think it's funny that she broke the same bone I did last year. Her discussion about the need for rest and recharging sounded like an echo. I think it is so important for us to realize we need rest after an "A" race or marathon. Also, as women, we need to understand the relationship between Vitamin D and the uptake of calcium. To read more about Deena's injury click here for the complete article. For more on metatarsal fracture in runners, click here.

Run Happy! Rest easy....and more than anything else...run forever my friends!

To purchase a copy of Dr Crane's new book "If Your Running Feet Could Talk" click here.