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Journal of Bone and Joint Surgery - British Volume, Vol 85-B, Issue 5,
700-705.
doi: 10.1302/0301-620X.85B5.13970 Copyright © 2003 by British Editorial Society of Bone and Joint Surgery Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunionT. A. Burd, MD, Chief Resident in Orthopaedics; M. S. Hughes, BS, Medical Student; and J. O. Anglen, MD, Clinical Professor, Orthopaedic SurgeryDepartment of Orthopaedic Surgery, The University of Missouri Hospital and Clinics, MC213 Columbia, Missouri 65212, USA. Correspondence should be sent to Professor J. O. Anglen. Indomethacin is commonly administered for the prophylaxis of heterotopic ossification (HO) after the surgical treatment of acetabular fractures. Non-steroidal anti-inflammatory drugs such as indomethacin, have been associated with delayed healing of fractures and mechanically weaker callus. Our aim was to determine if patients with an acetabular fracture, who received indomethacin for prophylaxis against HO, were at risk of delayed healing or nonunion of any associated fractures of long bones. We reviewed 282 patients who had had open reduction and internal fixation of an acetabular fracture. Patients at risk of HO were randomised to receive either radiation therapy (XRT) or indomethacin. Of these patients, 112 had sustained at least one concomitant fracture of a long bone; 36 needed no prophylaxis, 38 received focal radiation and 38 received indomethacin. Fifteen patients developed 16 nonunions. When comparing patients who received indomethacin with those who did not, a significant difference was noted in the rate of nonunion (26% v 7%; p = 0.004). Patients with concurrent fractures of the acetabulum and long bones who receive indomethacin have a significantly greater risk of nonunion of the fractures of the long bones when compared with those who receive XRT or no prophylaxis. This article has been cited by other articles:
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