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Postoperative Intravenous Ketorolac Does Not Affect Nonunion Risk in Surgically Treated Long Bone Shaft Fractures
Nicholas C Bank1, Stephen J Perle, Alexander D Jeffs
1From the Department of Orthopaedics (Dr. Bank, Dr. Jeffs, Dr. Orders, Dr. Chen), The University of North Carolina School of Medicine, Chapel Hill, NC; the Case Western Reserve University School of Medicine (Dr. Bank), Department of Orthopaedics, Cleveland, OH, and the The University of North Carolina School of Medicine (Perle, Mauffrey), Chapel Hill, NC.
Short-term postoperative intravenous ketorolac (a nonsteroidal anti-inflammatory drug) does not increase nonunion or revision surgery rates in adults with long bone fractures. This supports its use in multimodal pain management after orthopaedic surgery.
Area of Science:
- Orthopaedic Surgery
- Pharmacology
- Biomedical Engineering
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are crucial for managing orthopaedic pain and reducing opioid reliance.
- Concerns exist regarding NSAID effects on fracture healing, particularly with potent agents like ketorolac.
- The impact of short-term postoperative intravenous ketorolac on nonunion rates after long bone fracture fixation is not well-established.
Purpose of the Study:
- To investigate the association between short-term postoperative intravenous ketorolac administration and the risk of nonunion or nonunion-related revision surgery.
- To evaluate the safety of ketorolac in the context of long bone fracture healing.
- To inform pain management protocols in orthopaedic surgery.
Main Methods:
- Retrospective cohort analysis of adult patients undergoing surgical fixation of long bone fractures (femur, tibia, humerus, radius, ulna) from 2003-2023 using the TriNetX database.
- Exclusion of patients with infection, open fractures, or prior nonunion.
- Propensity score matching (1:1) to compare nonunion and revision surgery rates between patients receiving postoperative intravenous ketorolac within 5 days of surgery and those who did not.
Main Results:
- Analysis of 14,951 matched patients revealed no significant difference in overall nonunion rates (2.2% vs 1.9%) or revision surgery rates (1.2% vs 1.1%) between ketorolac and no-ketorolac groups.
- Subgroup analyses for tibial, femoral, and humeral fractures showed comparable nonunion rates.
- Age-stratified analyses did not indicate an increased risk of nonunion or revision surgery across different age groups.
Conclusions:
- Short-term postoperative intravenous ketorolac administration within 5 days of surgery is not associated with an increased risk of nonunion or related revision surgery for femoral, tibial, or humeral shaft fractures in low-risk adult patients.
- Findings support the judicious use of IV ketorolac as part of multimodal analgesia strategies in postoperative fracture care.
- This study contributes to evidence-based pain management in orthopaedic surgery, potentially reducing opioid use without compromising fracture healing.
