title: Does the Use of Ibuprofen in Children with Extremity Fractures Increase their Risk for Bone Healing Complications?
abstract: BACKGROUND
  Despite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing.
  
  
  OBJECTIVE
  To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures.
  
  
  METHODS
  We performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service. We chose these fractures due to their higher risk for complications. We classified patients as exposed if they received ibuprofen in the PED or during hospitalization or were prescribed ibuprofen at discharge. The main outcome was a bone healing complication as evidenced by nonunion, delayed union, or re-displacement on follow-up radiographs.
  
  
  RESULTS
  Of the 808 patients included in the final analysis, 338 (42%) were exposed to ibuprofen. Overall, 27 (3%) patients had a bone healing complication; 8 (1%) developed nonunion, 3 (0.4%) developed delayed union, and 16 (2%) developed re-displacement. Ten (3%) patients who were exposed to ibuprofen, and 17 (4%) who were not, developed a bone healing complication (odds ratio 0.8, 95% confidence interval 0.4-1.8; p = 0.61). There was no significant association between ibuprofen exposure and the development of a bone healing complication despite adjustment for potential confounders.
  
  
  CONCLUSIONS
  Children with extremity fractures who are exposed to ibuprofen do not seem to be at increased risk for clinically important bone healing complications.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.
authors.forename: Kerrin C
authors.initials: KC
authors.lastname: DePeter
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Blumberg
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dienstag Becker
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Meltzer
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000188:drug therapy; D017102:Fracture Healing / Q000187:drug effects*; D050723:Fractures, Bone / Q000188:drug therapy*; D006801:Humans; D006810:Humeral Fractures / Q000188:drug therapy; D007052:Ibuprofen / Q000009:adverse effects* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008684:Metatarsus / Q000293:injuries; D012189:Retrospective Studies; D012307:Risk Factors; D012540:Scapula / Q000187:drug effects / Q000293:injuries; D013978:Tibial Fractures / Q000188:drug therapy
chemical_list: D000700:Analgesics; D007052:Ibuprofen
keywords: NSAID; delayed union; fracture; ibuprofen; nonunion; re-displacement