Postoperative Ketorolac Use and the Odds of a Nonunion in Operatively Treated Scaphoid Fractures

Ketorolac is a potent nonsteroidal anti-inflammatory drug that is beneficial in the ambulatory hand surgery setting. Reluctance exists in the use of nonsteroidal anti-inflammatory drugs, such as ketorolac, after operative treatment of fractures at high risk for nonunion, such as scaphoid fractures. We hypothesized that postoperative ketorolac administration within 5 days of operative treatment for a scaphoid fracture would coincide with a higher rate of nonunion than no postoperative ketorolac administration.

A retrospective cohort was obtained from the TriNetX database. Patients ≥18 years old who underwent operative treatment of a scaphoid fracture from 2013 to 2023 were included. Patients with open fractures, prior nonunion, and infection were excluded. Cohorts were defined based on postoperative ketorolac use within 5 days of surgery. After propensity score matching, nonunion and nonunion revision surgery rates were determined and compared with odds ratios (ORs) and 95% CIs. Statistical significance was reported as an alpha error of < .05.

A total of 2,063 matched patients (1,044 ketorolac; 1,019 no ketorolac) were compared. No considerable differences in nonunion rate and nonunion revision surgery rate were observed between the ketorolac and no ketorolac groups (4.3% vs 3.9%; OR, 1.102 [95% CI, 0.714-1.703] and 1.0% vs 1.5%; OR, 0.655 [95% CI, 0.302-1.417]).

Postoperative ketorolac use within 5 days of operative treatment does not considerably increase the rate of nonunion or nonunion revision surgery in operatively treated scaphoid fractures.

Therapeutic III.