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The Effects Of Proton-pump Inhibitor Therapy On Scaphoid Fracture Healing: A Retrospective Cohort Study
Ethan R. Lester, BA, Diala Burjak, MD, Mackenzie French, MD, Brooke Allen, BS, Joy Ha, BA, Devin Eddington, MS, Christopher Goodenough, MD, MPH.
University of Utah, Salt Lake City, UT, USA.
PURPOSE: Scaphoid fractures are prone to healing complications with an estimated nonunion rate of around 2-5%. (2) Proton-pump inhibitors (PPIs) have been shown to negatively impact bone in other fracture types. (3, 4) There are no current recommendations for PPI use following scaphoid fractures.
METHODS: We conducted a retrospective cohort study using the TriNetX Research Network. Patients with scaphoid fractures between 2005 and 2025 were identified using ICD-10 codes and stratified into two cohorts—those with and without documented PPI within 30 days of injury. The cohorts underwent 1:1 propensity score matching to create matched pairs. Primary outcomes were rates of delayed fracture healing or nonunion. The analysis was repeated for both displaced and nondisplaced fractures.
RESULTS: 267,266 scaphoid fracture patients were identified- 7,315 with PPI use in the first 30 days after their injury, and 259,951 patients without PPI use. Propensity score matching yielded 7,257 matched pairs. The risk of delayed fracture healing or nonunion was significantly greater in patients who took PPI medications (3.94% vs. 2.69%; risk ratio [RR] 1.47; p<0.0001). In displaced scaphoid fractures only, 3,322 matched pairs were identified and overall risk was greater in those who took PPIs (3.46% vs. 2.26%; RR 1.53; p=0.0032). Outcomes were not significant in comparison of only nondisplaced scaphoid fractures.
CONCLUSION: PPI use in the first 30 days after sustaining a displaced scaphoid fracture is associated with increased risk of delayed fracture healing or nonunion. Patients with displaced scaphoid fractures should consider avoidance of PPIs in the immediate post-injury period.
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