I'm a PGY4 medical center. And I'll be discussing a study that we did comparing the rate of non-union or delayed union in fifth metatarsal fractures receiving anti-inflammatory medications. And I'd just like to acknowledge our co-authors. And we have no relevant disclosures. So for some background, non-union and delayed union of all fractures have significant implications in the care of orthopedic patients. And it's a multifactorial phenomenon. So controversy does exist regarding the acute effect of common NSAIDs on early fracture healing. There have been some prior animal studies and retrospective studies which have demonstrated that fracture union may be impaired by NSAID treatment. So our goal was to try to get some more information to determine if there is actually an effect here. For some background on fifth metatarsal fractures, fifth metatarsal fractures, especially base fractures, are relatively common injuries amongst athletes. There's a higher tendency for non-union or delayed union in the watershed zone with rates as high as 15% to 30%, especially zone two fractures. Managed either with an initial period of protected versus not post-monitoring versus initial RAF. So the purpose of our current study was to retrospectively compare two groups of subjects diagnosed with fifth metatarsal fractures. The two groups were those receiving a prescription on an outpatient basis for common NSAIDs and those not receiving an end subscript. We then followed these patients out to determine the rate of delayed open reduction internal fixation or non-union repair and then use this as a surrogate for non-union or delayed union in these patients. So our methods, what we did was we used the Pearl Diver data mining software, writing customizable code to look at the Humana Orthopedic Insurance Database of over 25 million patients. We isolated out patients with fifth metatarsal fracture using ICD and CPT coding. All subjects diagnosed with a fifth metatarsal fracture receiving early surgical management within 60 days of initial diagnosis were excluded. And then we isolated, like I said, out the treatment groups receiving an NSAID prescription and not receiving an NSAID prescription. Finally, the groups were followed and if they received RAF or non-union repair greater than 60 days after initial diagnosis, those were placed in the non-union or delayed union group. So looking at our results, you can see in this database we had around 10,600 patients with fifth metatarsal fracture. Of those, about 15% or 1,600 did receive an NSAID script on an outpatient basis. And then about 9,000 or 85% did not receive. You can see that the rate of delayed RAF or non-union repair was 1.1%. So pretty small, but 1.1% in the NSAID group or about half of a percent in the NSAID or non-NSAID group. So it was statistically different, but the differences are small. The NSAIDs that we studied from other papers that have looked at this were ibuprofen, flurbuprofen, catorlac, paroxychem, indomethacin, molexicam, silicoxid, declofenac, naproxen, and nabunatone. So for some discussion points on this, the rate of delayed RAF or non-union or malunion repair of fifth metatarsal fractures was significantly higher in subjects receiving anti-inflammatories within 60 days of initial diagnosis. So this study specifically isolates a specific fracture with a higher likelihood of non-union and then finds a negative correlation between NSAIDs and fracture healing. So with studies like this, large database studies gives you very high power, but it's hard to really guide clinical treatment based on one study alone, especially this type of study. So the reason for doing a study like this is to try to warrant higher-level studies to determine the effect of NSAIDs on fracture healing in specific high-risk fractures. So limitations with a study like this, it's retrospective in nature, it's a large database study, and it relies on accurate ICD and CPT coding. Additionally, based on ICD-9 coding, you're unable to isolate base of fifth metatarsal fractures or Jones fractures. Over time, with ICD-10 coding, this actually will be able to be completed. And then this only accounts for patients receiving a prescription for common NSAIDs. So this doesn't account for patients going buying these over the counter or receiving a short course while inpatient. Finally, there's a lack of long-term follow-up greater than 10 years. Thank you.

fifth metatarsal fractures

anti-inflammatory medications

NSAIDs

fracture healing

delayed non-union