Medication Summary

Medication for trauma-related fractures includes pain medication as indicated for reasonable pain. Anti-coagulants are used for a short course following traumatic fracture and operatively treated fractures to prevent venous thromboembolism.^[1]Vitamin D and calcium supplementation is recommended for patients found to be deficient on laboratory evaluation.

Animal studies have suggested nonsteroidal anti-inflammatory medications (NSAIDs) may have a detrimental effect on bone healing.^[34]These medications are typically avoided in the early stages of fracture healing.

For more information, see Medscape Drugs & Diseases topics Opioid Toxicity and Nonsteroidal Anti-inflammatory Agent Toxicity.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients with trauma.

Codeine/acetaminophen (Tylenol With Codeine)

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Indicated for mild to moderate pain.

Hydrocodone and acetaminophen (Lortab, Norcet, Vicodin)

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Drug combination for moderate to severe pain.

Propoxyphene/acetaminophen (Darvocet N-100, Propacet)

Drug combination for mild to moderate pain.

Follow-up

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Media Gallery

An example of an isolated, short, oblique midshaft femur fracture. Although not seen in this x-ray film, radiographic visualization of both the proximal and distal joints should be performed for all diaphyseal fractures.
Radiograph of a high-energy femoral shaft fracture.
Radiograph of a high-energy femoral shaft fracture.
Radiograph of an intra-articular distal femur fracture.
Radiograph of an intra-articular distal femur fracture.
Full length AP radiograph of an intertrochanteric fracture.
MRI of a patient with a stress fracture at the base of the femoral neck.
AP radiograph of a healing femoral shaft fracture after intramedullary nailing.
Lateral radiograph of a healing femoral shaft fracture after intramedullary nailing.
An intra-articular distal femur fracture treated with intramedullary nailing as well as independent screw fixation.
An intra-articular distal femur fracture treated with intramedullary nailing as well as independent screw fixation.

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Author

Nicholas M Romeo, DO Resident Physician, Department of Orthopedic Surgery, Wellspan York Hospital

Nicholas M Romeo, DO is a member of the following medical societies: American Osteopathic Association, American Osteopathic Academy of Orthopedics, Pennsylvania Osteopathic Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

John R Deitch, MD Director of Sports Medicine, Wellspan Orthopedics

John R Deitch, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Pennsylvania Orthopaedic Society

Disclosure: Nothing to disclose.

Thomas G DiPasquale, DO, FACOS, FAOAO Medical Director, Orthopedic Trauma Services, Director, Orthopedic Trauma Fellowship and Orthopedic Residency Programs, York Hospital; Orthopedic Trauma Consultant, Florida Orthopedic Institute, Tampa General Hospital

Thomas G DiPasquale, DO, FACOS, FAOAO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Osteopathic Association, Florida Medical Association, Florida Orthopaedic Society, American Osteopathic Academy of Orthopedics, Florida Osteopathic Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Acknowledgements

Douglas F Aukerman, MD Associate Professor, Department of Orthopedics and Rehabilitation, Division of Sports Medicine, Department of Family Medicine, Pennsylvania State University College of Medicine

Douglas F Aukerman, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

William Ertl, MD Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma College of Medicine

Disclosure: Nothing to disclose.