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DOI: 10.1055/s-2003-42286
© Georg Thieme Verlag Stuttgart · New York
Fracture Repair and the Role of Anti-Inflammatory Drugs: Deleterious Effects of Diclofenac but not of Dexamethasone
Publikationsverlauf
Publikationsdatum:
24. September 2003 (online)
Abstract
Anti-inflammatory drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), are routinely used in traumatology for reduction of pain and swelling after injury. Though these beneficial effects are proven beyond doubt, the concern remains that these drugs might impair fracture healing. To test this hypothesis, fracture healing was studied in 100 mice treated with either anti-inflammatory drugs (i. e., diclofenac, dexamethasone) or placebo. Anti-inflammatory drugs were given in doses (per kg) similar to the ones used in humans and for different periods of time to mimic chronic or acute use of these drugs. To make mouse models accessible to fracture modulation studies that also allow biomechanical analysis, we modified the Einhorn tibial fracture model and developed a standardized closed femur fracture model. Analysis included biomechanics, contact radiography, microCT analysis, undecalcified histology, histomorphometry and immunocytochemical analysis. Mice treated with diclofenac showed a significant impairment of fracture healing, whereas treatment with dexamethasone had no discernible effect. This study shows that NSAIDs can impair the fracture healing process in vivo, leading to significantly reduced biomechanical stability. As these drugs are widely used in patients with fractures, it seems important that further experimental and clinical studies clarify the role of these substances in fracture healing.
Key words
NSAIDs - biomechanics - fracture repair
References
- 1 Bazan N G, Flower R J. Medicine: Lipid signals in pain control. Nature. 2002; 420 135-138
- 2 Bolander M E. Regulation of fracture repair by growth factors. Proc Soc Exp Biol Med. 1992; 200 165-170
- 3 Einhorn T A. Do inhibitors of cyclooxygenase-2 impair bone healing?. J Bone Miner Res. 2002; 17 977-978
1 * These authors contributed equally and therefore share first authorship.
PD Dr. Michael Amling
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie
Universitätsklinikum Hamburg-Eppendorf
Martinistrasse 52
20246 Hamburg
Germany
Telefon: +49/40-4 28 03-60 83
Fax: +49/40-4 28 03-80 10
eMail: amling@uke.uni-hamburg.de