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J Wrist Surg
DOI: 10.1055/a-2753-9958
Scientific Article

Risk of Nonunion Associated with NSAID Use Following Partial Wrist Fusion: A Retrospective Analysis

Authors

  • Kira L. Smith 

    1   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
    2   Department of Hand and Upper Extremity, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

  • Cyrus F. Eghtedari

    2   Department of Hand and Upper Extremity, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

  • Alexander N. Berk 

    1   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
    2   Department of Hand and Upper Extremity, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

  • Logan Good 

    1   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
    2   Department of Hand and Upper Extremity, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

  • Kevin J. Malone

    1   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
    2   Department of Hand and Upper Extremity, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

  • Matthew V. Abola 

    3   Department of Hand and Upper Extremity, Hospital for Special Surgery, New York, New York, United States

Funding Information No funding, grants, or in-kind support were received for the purposes of this research.
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Abstract

Introduction

The purpose of this investigation was to assess whether the use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase-2 (COX-2) inhibitors in the perioperative period is associated with the risk of nonunion after partial wrist fusion. We hypothesized that exposure to nonselective NSAIDs or selective COX-2 inhibitors would not increase the rate of nonunion after partial wrist fusion when compared with control cohorts.

Materials and Methods

The TriNetX U.S. Collaborative database was queried using Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Revision (ICD-10) codes to identify patients aged 18 and older who underwent partial wrist fusion between 2008 and 2023. Patients were stratified according to the chronicity and type of NSAID use, including chronic NSAID use (within 90 days of surgery), acute NSAID use (within 30 days of surgery), perioperative ketorolac (Toradol) use (within 24 hours of surgery), and selective COX-2 inhibitor use (within 30 days of surgery). The cohorts were propensity-matched by age, gender, race, ethnicity, body mass index (BMI; kg/m2), and presence of type 2 diabetes mellitus. The risk of nonunion, defined as the need for revision fusion, conversion to total wrist arthrodesis, or conversion to total wrist arthroplasty, was assessed within the 1-year postoperative period. Chi-square analyses were used to compare the rate of nonunion for each cohort. Statistical significance was determined to be a p-value <0.05.

Results

A total of 3,073 patients undergoing partial wrist fusion were identified, of which 2,072 had a documented history of perioperative NSAID use. After 1:1 propensity score matching, the cohorts included 1,148 patients in the chronic NSAID group, 889 in the acute NSAID group, 482 in the Toradol group, and 140 in the COX-2 inhibitor group. The rate of nonunion was significantly higher in patients exposed to NSAIDs within 30 days of surgery (5.96%) compared with the control cohort (3.04%; p = 0.003). However, chronic exposure to NSAIDs or perioperative Toradol was not associated with a higher rate of nonunion (p = 0.17 and p = 0.56, respectively). Additionally, use of selective COX-2 inhibitors versus nonselective COX-2 inhibitors had no significant impact on the rate of nonunion (p = 0.66).

Conclusion

Patients exposed to NSAIDs within 30 days of a partial wrist fusion had an increased risk of nonunion when compared with a control cohort. Acute use of NSAIDs may be a risk factor for impaired bone healing after partial wrist fusion, and their use should be carefully considered in high-risk patients.

Keywords

partial wrist arthrodesis - four-corner fusion - nonsteroidal anti-inflammatory drugs - selective COX-2 inhibitors - nonunion

Ethical Approval

No IRB approval was required as our analysis does not contain human data.


Informed Consent

Not applicable.


Supplementary Material



Publication History

Received: 19 September 2025

Accepted: 18 November 2025

Article published online:
08 December 2025

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