Nonunion of metacarpal fractures associated with NSAID use: a case report

Introduction and Importance: The association between nonsteroidal anti-inflammatory drug (NSAID) use and impairment of fracture healing has been reported in the orthopedic literature. Multiple laboratory and clinical studies have shown a correlation between NSAIDs and fracture nonunion. Case Presentation: We present a series of two patients with fourth metacarpal fractures treated with surgery whose course was complicated by nonunion and fixation failure. Neither fracture healed successfully despite multiple revision surgeries until the patients discontinued their high-dose NSAID use. Each patient was followed for 6 months after their final surgery following cessation of NSAID use to confirm bony healing without any complications. Clinical Discussion: While NSAIDs are frequently utilized for postoperative pain control, they have been implicated in impaired fracture healing and subsequent fracture nonunion. Conclusion: In addition to other etiologies such as infection and metabolic abnormalities, physicians should pay attention to a patient’s NSAID use as a potential cause for fracture nonunion.