Purpose of review: The purpose of this review was to critically appraise the literature and establish an evidence-based clinical guideline for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in a fracture setting.
Recent findings: With few exceptions, studies in animals suggest that NSAIDs impair fracture healing. It is unclear if nonselective or cyclooxygenase-(COX)2-selective NSAIDs pose differing effects on fracture healing. Human studies show NSAID use to be a consistent risk factor for fracture non-union in skeletally mature populations across the literature and indicates that indomethacin in particular poses a significant risk for non-union of adult acetabular fractures. Current evidence appears to suggest no harm in using ketorolac or ibuprofen in a pediatric fracture population, while indomethacin poses a significant risk for non-union in adult acetabular fracture patients when used for six weeks. Despite the majority of available clinical studies showing NSAID use as a recurring risk factor for fracture non-union in adult populations, a lack of standardization amongst studies makes it difficult to determine any clinical recommendations about timing, dosage, duration, or type of agent administered. More high-quality prospective studies are needed.
Keywords: Bone healing; Cyclooxygenase; Fracture; Non-steroidal anti-inflammatory Drugs; Non-union.
© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.