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NSAIDs and risk of fracture non-union: avoid indomethacin

In this analysis1, six RCTs (609 patients) were included. The risk of non-union was higher in the patients who were given NSAIDs after the fracture, with an OR of 3.47. 

However, once the studies were categorized into the duration of treatment with NSAIDs, those who received NSAIDs for a short period (<2 weeks) did not show any significant risk of non-union compared to those who received NSAIDs for a long period (>4 weeks).

Indomethacin was associated with a significantly higher non-union rate and OR ranging from 1.66 to 9.03 compared with other NSAIDs that did not show a significant non-union risk. This is not the best evidence, but perhaps we should avoid indomethacin. 

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