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!

Ow Ming! Is Yao Ming's Basketball Career Over From a Foot Fracture?

Ow Ming!

Houston Rocket's Yao Ming's career may be over due to a non-healing foot fracture. He was sidelined during the playoffs on May 8th with a hairline fracture of his navicular. As of today, this has not healed properly. The nature of his non-union and his prognosis is being kept quiet by the team physicians, but it is evident that there is a problem. Most stress fractures heal completely in 6 to 8 weeks. This is not the 7 foot 6 inch center's first fracture. He has been out portions of the last three seasons with stress fractures in his leg and foot. Perhaps his lanky frame just can' handle the stress of the NBA? Why is it that some fractures don't heal?

Looking at his present injury, stress fractures of the navicular (the cornerstone of your arch) are often slow to heal due to three factors, blood supply to the bone itself, underestimating the extent of the initial fracture so delaying aggressive treatment and too much abnormal stress on the healing bone. Other medical issues can delay bone healing like lack of Vitamin D, poor calcium uptake and many other systemic problems like diabetes, hypothyroidism and peripheral vascular disease. Many of these fractures are actually missed due to lack of specific x-ray findings. Many fractures are actually misdiagnosed for months. Plain film x-rays are often read as normal so the fracture is missed until symptoms increase. Early symptoms can be diffuse and non-specific so the index of suspicion is also low. A bone scan, MRI or CT scan can identify the specific fracture. CT scan is often the most helpful in identifying the extent of the fracture and guiding treatment. For a non-displaced stress fracture, cast immobilization is the first line therapy. Studies have shown that non-weight bearing immobilization in a cast for at least 6 weeks is usually around 80-86% successful. For those that do not heal this way, surgical fixation of the fracture can be helpful and a bone graft may be needed for long standing non-unions. New technologies like electronic and ultrasonic bone stimulators and injectable platelet rich plasma can help even the most stubborn fractures.

Follow up care for a navicular fracture often includes physical therapy and custom foot orthotics. Abnormal biomechanics of the foot often are one of the causes of these fractures, so biomechanical control is crucial to distribute the abnormal stress so an athlete can return to sports and have a lower risk of recurrence.

Yao Ming has had multiple stress fractures during his career increasing the likelihood of traumatic arthritis from avascular necrosis (not enough blood supply to heal so the bone crumbles) in his foot causing him to retire. The next few months will tell the tale for this multi-million dollar All Star. Can he heal his fracture and return to sport? The Rocket's fans are praying for divine intervention to cure their dominant center.