Medication Summary
Drugs used to treat fractures are generally nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and anxiolytics.
Nonsteroidal anti-inflammatory agents (NSAIDs)
Class Summary
These drugs are most commonly used for relief of mild to moderately severe pain. Effects of NSAIDs in treatment of pain tend to be patient specific, yet ibuprofen is usually DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.
Ibuprofen (Ibuprin, Advil, Motrin)
Usually DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which inhibits prostaglandin synthesis.
Ketoprofen (Oruvail, Orudis, Actron)
Used for relief of mild to moderately severe pain and inflammation.
Administer small dosages initially to patients with small bodies, older persons, and those with renal or liver disease. Doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.
Naproxen (Anaprox, Naprelan, Naprosyn)
Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which decreases prostaglandin synthesis.
Flurbiprofen (Ansaid)
Has analgesic, antipyretic, and anti-inflammatory effects. May inhibit cyclooxygenase enzyme, inhibiting prostaglandin biosynthesis.
Analgesics
Class Summary
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures.
Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)
DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, or those taking oral anticoagulants.
Hydrocodone bitartrate and acetaminophen (Vicodin ES)
Drug combination indicated for relief of moderately severe to severe pain.
Acetaminophen and codeine (Tylenol #3)
Drug combination indicated for treatment of mild to moderately severe pain.
Oxycodone and acetaminophen (Percocet)
Drug combination indicated for relief of moderately severe to severe pain. DOC for aspirin-hypersensitive patients.
Anxiolytics
Class Summary
Patients with painful injuries usually experience significant anxiety. Anxiolytics allow administration of smaller analgesic dose to achieve same effect.
Lorazepam (Ativan)
Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent for sedating patients for >24 h. Monitor patient's BP after administering dose and adjust as necessary.
Hogan TM. Hip and femur. In: Hart RG, Rittenberry TJ, Uehara DT, eds. Handbook of Orthopaedic Emergencies. Publishers: Lippincott Williams & Wilkins; 1999:307-8.
Braten M, Helland P, Myhre HO, Molster A, Terjesen T. 11 femoral fractures with vascular injury: good outcome with early vascular repair and internal fixation. Acta Orthop Scand. Apr 1996;67(2):161-4. [Medline].
DiChristina DG, Riemer BL, Butterfield SL, Burke CJ 3rd, Herron MK, Phillips DJ. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. Dec 1994;8(6):494-503. [Medline].
Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. Jul 1997;43(1):117-22. [Medline].
Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases. Ann Chir Gynaecol. 1997;86(4):326-36. [Medline].
Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma. Jan 1996;40(1):17-21. [Medline].
Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. Nov 1996;7(6):612-8. [Medline].
Harrington KD. Orthopaedic management of extremity and pelvic lesions. Clin Orthop. Mar 1995;(312):136-47. [Medline].
Mohr VD, Eickhoff U, Haaker R, Klammer HL. External fixation of open femoral shaft fractures. J Trauma. Apr 1995;38(4):648-52. [Medline].
Macnicol MF. Fracture of the femur in children. J Bone Joint Surg Br. Nov 1997;79(6):891-2. [Medline].
Kanel JS. Treatment of fractures of the femur in children and adolescents. West J Med. Dec 1995;163(6):570. [Medline].
Illgen R 2nd, Rodgers WB, Hresko MT, Waters PM, Zurakowski D, Kasser JR. Femur fractures in children: treatment with early sitting spica casting. J Pediatr Orthop. Jul-Aug 1998;18(4):481-7. [Medline].
Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop. May-Jun 1997;17(3):342-6. [Medline].
Clinkscales CM, Peterson HA. Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods. Orthopedics. Dec 1997;20(12):1131-6. [Medline].
Mahaisavariya B, Laupattarakasem W. Late open nailing for neglected femoral shaft fractures. Injury. Oct 1995;26(8):527-9. [Medline].
Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop. Sep-Oct 1996;16(5):621-6. [Medline].
Lefaivre KA, Starr AJ, Stahel PF, Elliott AC, Smith WR. Prediction of pulmonary morbidity and mortality in patients with femur fracture. J Trauma. Dec 2010;69(6):1527-35; discussion 1535-6. [Medline].
Sartoretti C, Sartoretti-Schefer S, Ruckert R, Buchmann P. Comorbid conditions in old patients with femur fractures. J Trauma. Oct 1997;43(4):570-7. [Medline].
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