brand logo

Am Fam Physician. 2024;109(4):376-377

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• NSAIDs improve pain control and decrease opioid use in adults with traumatic fractures and should be used in most patients.

• NSAIDs may slightly increase the likelihood of nonunion.

• Opioid use after fracture also appears to increase the risk of nonunion. 

• Intravenous ketorolac is beneficial in the acute care of adult patients with a traumatic fracture without increasing fracture nonunion.

From the AFP Editors

Opioids have been traditionally used for analgesia after orthopedic trauma because of concern that nonsteroidal anti-inflammatory drug (NSAID) use increases fracture nonunion. Because opioid misuse and abuse have risen to critical levels and opioid use has also been associated with fracture nonunion, the safety of NSAID use after orthopedic trauma is an open question. The Eastern Association for the Surgery of Trauma and the Orthopaedic Trauma Association conducted systematic reviews to publish guidelines for the use of NSAIDs after traumatic orthopedic fractures in adults with regard to acute pain control and risk of nonunion.

Risk of Nonunion

NSAIDs are recommended after fracture because the benefit of improved acute pain control outweighs the low risk of nonunion. Although NSAID use increased fracture non-union in more than 600,000 patients studied, the number needed to harm was 105 (95% CI, 47 to 1,173) compared with not using an NSAID. The risk might be slightly higher with chronic NSAID use before fracture, with indomethacin, and in patients with hip fracture.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2024 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.