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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.
Background:
Nonsteroidal anti-inflammatory drugs (NSAIDs) have become an increasingly important component of orthopaedic pain management protocols in an effort to reduce dependence on opioids. However, concerns remain regarding their potential impact on fracture healing. Ketorolac is a potent NSAID commonly administered postoperatively in orthopaedic surgery, but its effects on nonunion rates remain unclear. This study aims to evaluate whether short-term postoperative intravenous (IV) ketorolac administration is associated with an increased risk of nonunion or nonunion-related revision surgery in patients undergoing surgical fixation of long bone fractures.
Methods:
A retrospective cohort analysis was done using the TriNetX database. Adult patients who underwent surgical fixation of femoral, tibial, humeral, radial, or ulnar shaft fractures between 2003 to 2023 were included. Patients with infection, open fractures, or a history of nonunion were excluded. Cohorts were defined based on postoperative IV ketorolac use within 5 days of surgery. After 1:1 propensity score matching for demographics and comorbidities, nonunion and revision surgery rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were done by fracture type and age group.
Results:
A total of 14,951 matched patients (7464 ketorolac; 7487 no ketorolac) were analyzed. No notable differences in nonunion rates were observed between the ketorolac and no ketorolac groups overall (2.2% vs 1.9%; OR 1.187 [95% CI, 0.941 to 1.498]) or within the tibial, femoral, or humeral subgroups. Ulnar and radial shaft fractures lacked sufficient sample sizes for subgroup analysis. Revision surgery rates were likewise comparable between the groups (1.2% vs 1.1%; OR 1.094 [95% CI, 0.803 to 1.491]). Age-stratified analyses showed no increased risk across age groups (18 to 29, 30 to 64, ≥65 years).
Conclusions:
Postoperative administration of IV ketorolac within 5 days of surgery does not increase the odds of nonunion or nonunion-related revision surgery for femoral, tibial, or humeral shaft fractures in low-risk adults. These findings support the use of short-duration IV ketorolac as part of multimodal analgesia protocols in postoperative fracture care.
