2025 AAOS Annual Meeting: Conservative versus Surgical Treatment for the Displaced, Distal Diaphyseal-Metaphyseal Fifth Metatarsal Fractures: A Prospective, Randomized Controlled Study

Nine randomized controlled trials (RCTs) including 1,104 patients undergoing fracture fixation were analyzed in this meta-analysis comparing NSAIDs to a control group for pain management. The primary outcome was radiographic nonunion. The pooled results showed that 8.9% of patients receiving NSAIDs experienced nonunion, compared to 3.9% in the control group. A subgroup analysis indicated that short-term NSAID use (<2 weeks) was still associated with an increased risk of nonunion. No cases of nonunion were observed in pediatric patients (p > 0.99). These findings suggest that NSAID use, even for short durations, may impair fracture healing and increase the risk of nonunion, highlighting the need for careful pain management strategies in fracture patients.