Report on Hands from Doctors Demystify, June 2012
CONTENTS
DD Courses
Journal Article Review: The effect of NSAIDs on hand and wrist fracture healing
Digital prostheses, both functional and aesthetic
DOCTORS DEMYSTIFY COURSES
CURRENT SCIENCE for HAND THERAPISTS
July 12-14, 2012, Boston Sold out.
Miami Feb 17-19, 2013, and Santa Monica Aug ??, 2013. Details by Aug 2012.
ON LINE and FREE at www.doctorsdemystify.com
Doctors Demystify Bracing Innovation
Doctors Demystify Thumb Basal Joint Arthritis
FUN SUMMER READING (and earn CE credit)
The Hand Owner’s Manual.
Read the hand therapists’ reviews at Amazon.
Read the review from J Hand Therapy.
Order from Amazon for as little as $7.57. Kindle Edition $8.39.
Register and take the quiz. $50 for 10 hours of CE credit.
JOURNAL ARTICLE REVIEW The Effects of NSAIDs on hand and wrist
fracture healing
Consider a patient receiving hand therapy after recently breaking her wrist. She tells you
that she is taking Advil for pain control without having consulted her doctor. Should you
be concerned that the non-steroidal anti-inflammatory drug (NSAID) is retarding fracture
healing and therefore complicating your therapy efforts?
The answer is nuanced. A thorough review of the subject appeared recently in the Journal
of Bone and Joint Surgery. The authors performed a structured search for laboratory and
clinical studies regarding NSAIDs and fracture healing. They summarized the results
from the 83 highest-quality papers.
Bone healing is a complex biomolecular process in part regulated by the effect of
prostaglandins on osteoblasts and osteoclasts. NSAIDs inhibit cyclo-oxygenase (COX),
an enzyme necessary for the manufacture of prostaglandins. In mouse, rat, and rabbit
experiments, NSAIDs retard fracture healing related to timing and to dose. NSAID
administration in the first few days after fracture and at high doses delays healing and
contributes to an increased nonunion rate in various experimental, mainly rodent, models.
There is fairly good evidence that NSAID administration following vertebral fusion in
humans leads to a higher nonunion rate.
Studying fractures in humans, the picture is not so clear because there are questions
regarding how well fracture studies in experimental animals and spine fusion studies in
humans can be extrapolated to human appendicular fractures. Several studies of long
bone fractures have indicated an increased rate of nonunion in patients treated with
NSAIDs, although these studies were principally uncontrolled and retrospective. Patients
with comorbidities such as diabetes, smoking, obesity, and poor nutrition are known to
heal fractures more slowly; these patients may be taking more NSAIDs, so it is difficult
to know whether the NSAID ingestion contributes to their slow healing or only makes the
patient more comfortable during the elongated recovery propagated by the comorbidities.
A prospective clinical trial would have to be huge in order to separate the effects of
comorbidities from that of NSAID use, especially since the effects are subtle.
The authors conclude: “At present, although theoretical concerns about the adverse
effects of NSAIDs on fracture-healing exist, there is not enough clinical evidence to deny
patients with simple fractures the analgesic benefits of these compounds. “ Abstract:
http://www.ncbi.nlm.nih.gov/pubmed/22552671
PROSTHETIC FINGERS: AESTHETIC AND FUNCTIONAL
Have a look at these videoclips. Pretty cool engineering going on.
Here, motion at the intact MP joint powers the prosthetic IP joints in the same finger.
http://www.youtube.com/watch?v=dEX_0by9_30&feature=related
Here, the active motion at the MP joint in an adjacent finger powers the adjacent fingers.
http://www.youtube.com/watch?NR=1&v=NXtSPQp4hJM&feature=endscreen
Best wishes,
Roy A. Meals, MD
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