NSAIDs

[Zsolt Balogh]

Dear List Members,

As a trauma surgeon operating on both torso and musculo-skeletal injuries my approach based on the available evidence and my experience is:

- Fracture healing/bone formation / heterotropic ossification (HO) are inflammatory processes

- These processes could be altered by potent NSAIDs

- Short term 1-2 weeks NSAID has no effect on fracture healing

- I much prefer to give my patients to potentiate pain relief rather than narcotise them

- The inhibitory effects of NSAID namely Indomethacinum is proven in prevention of HO after posterior approaches used in acetabular fracture fixation.

- 3x25mg Indomethacinum is recommended for 6 weeks to prevent HO in these situations, since these patients frequently have long bone fxs, here the incidence of the delayed union/ non union is often obvious. The risk and benefit has to be justified with each individual. In my hands a delayed union on a long bone which is non-infected and well aligned without significant gap is easier to manage than a bad HO around a major joint.

- In summary as an orthopaedic trauma surgeon I am happy give NSAIDs during the acute phase (10-14 days) of postinjury recovery and routinely use it for HO prevention in my acetabular fracture reconstruction cases.

Best Regards,

Zsolt Balogh

A/Prof. Zsolt Balogh, MD, PhD, FRACS
Director of Trauma
John Hunter Hospital and Hunter New England Area Health Service
University of Newcastle
Newcastle, NSW
AUSTRALIA
Tel: +61 2 49214259
Fax: +61 2 29214274
E-mail: zsolt.balogh at hnehealth.nsw.gov.au


>>> "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za> 15/07/2008 11:31 pm >>>
Sorry

Just quoting the refs - I don't have them. Should be available on pubmed

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Sohail Muzammil
Sent: 15 July 2008 15:28
To: trauma-list at trauma.org 
Subject: Re: NSAIDs

Dr. Hardcastle could you forward PDFs of the articles you mentioned.
Wouldn't hurt to see the evidence for our current practice..!

Regards
S Muzammil, FRCS
Dept of Orthopaedics
Combined Military Hospital
Pano Aqil
Pakistan

From: "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Date: Tue, 15 Jul 2008 08:55:11 +0200
Subject: RE: NSAIDS
Ken and Norman and others:

I spoke to our ortho trauma surgeons and they referred me to a recent
overview in the British Edition of JBJS (Inhibition of fracture healing
M S Gaston <javascript:void(0);> , A H R W Simpson <javascript:void(0);>
. Journal of Bone and Joint Surgery
<http://proquest.umi.com.ez.sun.ac.za/pqdweb?RQT=318&pmid=28785&TS=12161 
04512&clientId=57290&VInst=PROD&VName=PQD&VType=PQD> . (British volume).
London: Dec 2007
<http://proquest.umi.com.ez.sun.ac.za/pqdweb?RQT=572&VType=PQD&VName=PQD 
&VInst=PROD&pmid=28785&pcid=38287321&SrchMode=3&aid=1> . Vol. 89, Iss.
12; pg. 1553, 8 pgs).

The section on NSAIDs has the following two human studies as references
suggesting that NSAID's delay healing significantly. I'm not necessarily
supporting the contention, just passing on the info.

 Burd TA, Hughes MS, Anglen JO. Heterotopic ossification prophylaxis
with indomethacin increases the risk of long-bone nonunion. J Bone Joint
Surg [Br] 2003;85-B:700-5.
 Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of the
femoral diaphysis: the influence of reaming and non-steroidal
anti-inflammatory drugs. J Bone Joint Surg /flr/2000;82-B:655-8.

Regards
Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

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