Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association

OBJECTIVES: Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. METHODS: Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. CONCLUSIONS: In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks

Hiperglucemia como factor de riesgo de infección temprana de la herida postoperatoria después de fracturas de la meseta tibial bicondilar: determinación de un modelo predictivo basado en cuatro métodos

Objetivos: identificar un umbral de glucosa que pondría a los pacientes con fracturas aisladas de la meseta tibial bicondilar en riesgo de infección temprana de la herida (es decir, .05). Los modelos de regresión logística para todos los métodos mostraron que tener una fractura abierta era el predictor más fuerte de infección. Conclusión: Es bien sabido que la hiperglucemia inducida por el estrés aumenta el riesgo de infección. Presentamos y comparamos cuatro modelos que se han utilizado en otros campos médicos. En nuestro estudio, ninguno de los métodos presentados identificó un umbral de glucosa que aumentaría el riesgo de infección en pacientes con fracturas de la meseta tibial bicondilar. Nivel de evidencia: Revisión retrospectiva, Nivel III. Consulte las Instrucciones para autores para obtener una descripción completa de los niveles de evidencia.Objectives: Identify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. .05). Logistic regression models for all the methods showed that having an open fracture was the strongest predictor of infection. Conclusion: It is well known that stress-induced hyperglycemia increases the risk of infection, we present and compare four models that have been used in other medical fields. In our study, none of the methods presented identified a glucose threshold that would increase the risk of infection in patients with bicondylar tibial plateau fractures. Level of Evidence: Retrospective review, Level III. See Instructions for Authors for a complete description of levels of evidence