Do non-steroidal anti-inflammatory medications or opioids increase the risk of nonunion after surgical and nonsurgical treatment of tibial shaft fractures?

Filling an NSAID prescription within 30 days after tibial shaft fracture diagnosis is linked to higher nonunion treatment risk, with an adjusted HR of 1.60 (95% CI 1.20–2.15).

• Why it matters: Nonunion after tibial shaft fractures is uncommon, and prior work may not have adequately addressed confounding, leaving uncertainty about whether NSAIDs or opioids independently relate to nonunion.
• What they did: In a propensity-matched cohort of 297,334 skeletally mature patients (ages 17–64) using Merative Marketscan claims (2007–2022), nonunion was defined as surgical treatment between 90–365 days; Cox models estimated adjusted HRs for NSAID or opioid fills in the 0–30 days after diagnosis.
• The result: Opioid fills in the same 30-day window were also linked to higher nonunion treatment rates (1.3% vs 0.9%; adjusted HR 1.41, 95% CI 1.19–1.66), while comparing NSAID-only versus opioid-only showed no significant difference (HR 0.89, 95% CI 0.45–1.76).

AI summary of the abstract · may contain errors · not medical advice · read the paper.