Ketorolac Use and Its Association With Craniofacial Fracture Healing Complications: Propensity Score-Matched Analyses

Nonunion is a major complication following craniofacial fracture repair. While ketorolac has been associated with impaired bone healing in other fractures, its effect on craniofacial bones remains unclear. This study evaluated the association between postoperative ketorolac use and nonunion after craniofacial fracture repair.

The TriNetX database was used to identify patients who underwent orbital, nasal, zygomatic, maxillary, and mandibular fracture repair. For each type of fracture, patients were classified into ketorolac-exposed and unexposed (control) cohorts. Propensity score-matching was used to adjust for various nonunion risk factors. The primary outcome was nonunion; secondary outcomes were malocclusion, hardware complications, wound dehiscence, and tooth extraction, assessed at 3, 6, and 9 months.

For mandibular fractures, 33,740 patients were included after propensity score matching, with 16,870 in the exposed cohort and 16,870 in the control cohort. At 3 months post-repair, patients with ketorolac use had an increased risk of nonunion (RR 2.35, P<0.001), malocclusion (RR 1.67, P<0.001), hardware complications (RR 2.61, P<0.001), wound dehiscence (RR 2.10, P<0.001), and tooth extraction (RR 1.67, P=0.002) with similar risks observed at 6 and 9 months. For other fracture types (orbital, nasal, zygomatic, maxillary), ketorolac use was not associated with increased nonunion risk, though secondary complications were significantly higher.

Postoperative ketorolac use is associated with a significantly increased risk of nonunion after mandibular fracture repair and a higher incidence of secondary complications across all craniofacial fracture types.