DePeter Kerrin C, Blumberg Stephen M, Dienstag Becker Sarah, Meltzer James A
Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.
Albert Einstein College of Medicine, Bronx, New York.
J Emerg Med. 2017 Apr;52(4):426-432. doi: 10.1016/j.jemermed.2016.09.027. Epub 2016 Oct 14.
Despite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing.
To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures.
We performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service. We chose these fractures due to their higher risk for complications. We classified patients as exposed if they received ibuprofen in the PED or during hospitalization or were prescribed ibuprofen at discharge. The main outcome was a bone healing complication as evidenced by nonunion, delayed union, or re-displacement on follow-up radiographs.
Of the 808 patients included in the final analysis, 338 (42%) were exposed to ibuprofen. Overall, 27 (3%) patients had a bone healing complication; 8 (1%) developed nonunion, 3 (0.4%) developed delayed union, and 16 (2%) developed re-displacement. Ten (3%) patients who were exposed to ibuprofen, and 17 (4%) who were not, developed a bone healing complication (odds ratio 0.8, 95% confidence interval 0.4-1.8; p = 0.61). There was no significant association between ibuprofen exposure and the development of a bone healing complication despite adjustment for potential confounders.
Children with extremity fractures who are exposed to ibuprofen do not seem to be at increased risk for clinically important bone healing complications.
尽管布洛芬对骨折儿童是一种有效的镇痛药，但一些临床医生可能因它对骨愈合有潜在有害影响而避免开具此药。
确定接触布洛芬是否与骨折儿童发生骨愈合并发症的风险增加相关。
我们对年龄在6个月至17岁之间、因胫骨、股骨、肱骨、舟骨或第五跖骨骨折到儿科急诊科就诊并接受骨科随访的儿童进行了一项回顾性研究。我们选择这些骨折是因为它们发生并发症的风险较高。如果患者在儿科急诊科或住院期间接受了布洛芬治疗，或出院时被开具了布洛芬，我们将其分类为暴露组。主要结局是随访X线片显示骨不连、延迟愈合或再移位所证实的骨愈合并发症。
在纳入最终分析的808例患者中，338例（42%）接触了布洛芬。总体而言，27例（3%）患者发生了骨愈合并发症；8例（1%）发生骨不连，3例（0.4%）发生延迟愈合，16例（2%）发生再移位。10例（3%）接触布洛芬的患者和17例（4%）未接触布洛芬的患者发生了骨愈合并发症（比值比0.8，95%置信区间0.4 - 1.8；p = 0.61）。尽管对潜在混杂因素进行了调整，但布洛芬暴露与骨愈合并发症的发生之间没有显著关联。
接触布洛芬的四肢骨折儿童似乎没有增加发生具有临床意义的骨愈合并发症的风险。
