title: The use of indomethacin in the prevention of postoperative radioulnar synostosis after distal biceps repair.
abstract: BACKGROUND
  This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification after distal biceps tendon repair in patients receiving indomethacin prophylaxis. We hypothesized that indomethacin use postoperatively would decrease the occurrence of symptomatic synostosis.
  
  
  METHODS
  A single-center retrospective record review identified 124 patients undergoing distal biceps repair between 2011 and 2014. Patients were analyzed for administration of indomethacin, contraindications to administration, age, time to surgery, fixation method, medical comorbidities, and development of symptomatic synostosis. Oral indomethacin (75 mg, once daily) was prescribed postoperatively for 10 to 42 days per each attendings' protocol.
  
  
  RESULTS
  After analysis, 112 patients met the inclusion criteria, with 7 undergoing a 1-incision distal biceps repair and 105 undergoing a 2-incision repair. Of those, 104 received indomethacin postoperatively, with a synostosis rate of 0.96% compared with 37.50% for the untreated group (P < .001). No statistically significant difference was found between fixation methods and synostosis. One patient with synostosis was a single-incision repair, and 3 were 2-incision suture bridge repairs. Three patients with synostosis had relative contraindications to administration of indomethacin, including concomitant warfarin use, clopidogrel use, and ulcerative colitis.
  
  
  CONCLUSIONS
  Indomethacin use after distal biceps repair was associated with a statistically significant reduction in the rate of symptomatic radioulnar synostosis and did not have any associated adverse effects, including gastrointestinal bleeding or rerupture, despite prolonged use of up to 6 weeks. This study represents the largest study to report the outcomes of patients undergoing distal biceps repair with concomitant synostosis prophylaxis using indomethacin.
authors.affiliation: Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA. Electronic address: callista.costopoulos@gmail.com.
authors.forename: Callista L
authors.initials: CL
authors.lastname: Costopoulos
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Ramsey
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Getz
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Sholder
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Taras
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Huttman
authors.affiliation: Department of Orthopedics, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lazarus
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001134:Arm Injuries / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D000070632:Hamstring Tendons / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011884:Radius / Q000002:abnormalities*; D012189:Retrospective Studies; D013580:Synostosis / Q000517:prevention & control*; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014457:Ulna / Q000002:abnormalities*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: 2-incision suture bridge repairs; Indomethacin prophylaxis; distal biceps tendon repair; heterotopic ossification; radioulnar synostosis; single incision repair