Comparison Of The Efficacy Of Selective COX-2 Inhibitor And Traditional NSAIDs For Prevention Of Heterotopic Ossification After Elbow Fracture Surgery

ObjectiveTo compare the early preventive effects of selective cyclooxygenase 2(COX-2)inhibitor celecoxib and classical NSAIDs Indometacin on the heterotopic ossification following surgical treatment for elbow joint.MethodsClinical data of elbow joint trauma patients in our hospital from 2014 to 2016 were collected and retrospectively analyzed.All the operations were done by the same group of doctors.Functional exercise was performed on the first day after surgery.A total of 57 patients were enrolled and followed up effectively,and they were divided into celecoxib group(n = 24),Indometacin group(n = 33).After surgery,24 patients received celecoxib(200 mg once daily)for 14 days,whereas 33 patients received indometacin(25 mg three times a day)for 14 days.The clinical outcomes were assessed in regard of Mayo elbow performance score,(MEPS),range of motion(ROM),and radiographic findings in the last follow-up.ResultsThere were four cases of heterotopic ossification in celecoxib group which which include 2 cases of type I,1 cases of type IIA and 1 cases of type IIC according to Hastings-Graham classification,whereas 1 cases of type I,1 cases of type IIA and 1cases of type IIC in the Indometacin group.The incidence of the final heterotopic ossification in the two groups was 16.7% and 9%.There was no significant difference(P>0.05).There were four cases of heterotopic ossification in celecoxib group,wheras three in the indometacin group.There are no statistically significant difference was found in overall incidence of HO(P=0.651).The average score of the final Mayo elbow performance score of the two groups was(89.1 ± 8.7)and(89.7 ± 7.7),and the difference was not statistically significant(P=0.791).Two groups of patients with the final elbow activity were(108.5± 11.9°)and(106.8±12.1),and there was no statistically significant difference(P=0.605).Side effects ofgastrointestinal discomfort were reported in 8.3% of patients(2 patients)in the celecoxib treatment group after an average of 14 days,whereas 30.3% of patients(10 patients)in the indometacin treatment group which included the withdrawal of 3patients with gastrointestinal side effects.A significant difference was observed between the 2 groups in terms of the incidence of gastrointestinal adverse reactions(P=0.045).ConclusionThe selective COX-2 inhibitors celecoxib are as equally effective as indometacin for the prevention of HO after surgery of elbow fracture.But taking into account the gastrointestinal adverse reactions of non selective NSAIDs drugs on patients,celecoxib may provide a more safe and effective solution for the prevention of heterotopic ossification.