Early Nonsteroidal Anti-Inflammatory Drug Prescriptions and Nonunion After Scaphoid Fractures: A TriNetX Matched Cohort Study.

PURPOSE: The purpose of our study was to evaluate the relationship of nonsteroidal anti-inflammatory drug (NSAID) use and nonunion rates in nonoperatively and operatively managed scaphoid fractures.

METHODS

We queried the TriNetX database to identify all patients diagnosed with scaphoid fractures. Patients were stratified by operative versus nonsurgical management, and by a prescription for NSAIDs within 1 month of scaphoid fracture diagnosis. We then assessed the incidence of scaphoid nonunion and the rate of salvage procedures for nonunion within 3 months to 2 years of the initial diagnosis of scaphoid fracture or scaphoid surgery. Chi-squared testing and odds ratio analysis were used to determine statistical significance.

RESULTS

After matching, there were 11,629 patients in each nonsurgical group and 1,063 patients in each operative group. Within the matched nonsurgical treatment cohorts, patients with prescription NSAIDs had a significantly increased incidence of scaphoid nonunion with an odds ratio of 1.7 (95% CI: 1.4-1.9) and significantly increased incidence of salvage procedures (odds ratio: 1.5; 95% CI: 1.2-1.9). In contrast, within the matched operative fracture group with and without perioperative NSAID prescriptions, there were no notable differences between the incidence of scaphoid nonunion, or of salvage procedures.

CONCLUSIONS

Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures. This association was not observed in operatively managed patients with perioperative prescribed NSAIDs, suggesting that mechanical fixation may offset the potential adverse effects of NSAIDs. These findings highlight the importance of appropriate patient counseling when deciding on NSAID use in the early postinjury period after scaphoid fractures, especially when nonsurgical management is planned.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IIc.