From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The patient's requested dose of ibuprofen 400 mg TIDPRN is within the recommended dosage for mild to moderate pain.
- The dose is 400 mg which is the recommended starting dose for mild to moderate pain.
- The frequency is every 4 to 6 hours as necessary, but the patient is taking it TIDPRN (three times a day as needed), which is a reasonable regimen.
- The total daily dose should not exceed 3200 mg, and the patient's dose of 400 mg TIDPRN is below this limit 1.
From the Research
The patient has a displaced medial malleolus fracture requiring immediate orthopedic care, and I recommend continued use of the walking boot and crutches with limited weight-bearing until the orthopedic consultation, along with pain management using ibuprofen 400 mg three times daily as needed and acetaminophen 650 mg three times daily as needed, alternating between the two medications for optimal pain control, as supported by the most recent study 2 which found that ibuprofen does not significantly affect the healing of nonsurgically treated fractures.
Current Treatment Plan
The current treatment plan includes:
- Continued use of the walking boot and crutches with limited weight-bearing until the orthopedic consultation
- Pain management using ibuprofen 400 mg three times daily as needed and acetaminophen 650 mg three times daily as needed, alternating between the two medications for optimal pain control
- Complete rest and elevation of the affected limb to reduce swelling and promote healing
- Application of ice for 20 minutes every 2-3 hours during waking hours for the first 48-72 hours
Rationale for Treatment Plan
The treatment plan is based on the most recent and highest quality study 2, which found that ibuprofen does not significantly affect the healing of nonsurgically treated fractures. Additionally, the study 3 found that intravenous acetaminophen may improve postoperative outcomes in hip fracture patients, but the evidence is limited and low-level. The study 4 also found that fascia iliaca compartment block improved postoperative pain on movement compared with intravenous acetaminophen, but this is not directly applicable to the current patient's situation.
Important Considerations
- The medial malleolus fracture involves the inner ankle bone and often requires surgical intervention due to its displaced nature, which is why the urgent orthopedic consultation is critical
- Regular follow-up appointments will be necessary to monitor healing progress and adjust the treatment plan accordingly
- The patient should be advised to follow the treatment plan carefully and attend all scheduled follow-up appointments to ensure proper healing and minimize the risk of complications.