Effect of ketorolac administration on the rate of nonunion of operatively treated humeral shaft fractures: A matched cohort analysis

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-08-23 DOI:10.1016/j.injury.2025.112689

Akhil Katakam , Tej Joshi , Tuckerman Jones , Eitan M Kohan , Francis G Alberta

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引用次数: 0

Abstract

Background

Humeral shaft fractures treated surgically have a 5–10 % risk of nonunion. NSAIDs, including ketorolac, are frequently prescribed postoperatively for pain management, but concerns persist regarding their effects on bone healing. Although prior studies suggest a potential association between ketorolac and nonunion, findings remain inconclusive. This study aims to assess the impact of ketorolac on nonunion risk in adults undergoing surgical treatment for humeral shaft fractures.

Methods

The TriNetX Research Database was queried using ICD and CPT codes to identify patients who underwent operative fixation of humeral shaft fractures with a minimum of 2 years of follow-up. Exclusion criteria included prior humeral shaft nonunion, pathologic fractures, and age under 18. Patients were divided into two cohorts based on whether they received ketorolac within 1 month postoperatively. Outcomes included nonunion diagnosis, nonunion surgery, opioid utilization, wound complications, superficial infection, deep infection, and hardware infection. Outcomes were analyzed at 30 days, 90 days, 1 year, 2 years, and final follow-up.

Results

There was no significant difference in opioid utilization within 30 days postoperatively (HR 1.051, 95 % CI 0.987–1.118, p = 0.073; prescriptions 3.2 ± 4.9 vs. 3.2 ± 5.0, p = 0.721). However, at 1-year, 2-year, and overall follow-up, patients receiving ketorolac demonstrated a significantly increased risk of nonunion surgery. At final follow-up (2.9 ± 2.8 years vs. 3.4 ± 3.5 years), nonunion incidence was not significantly different (4.7 % vs. 4.2 %, p = 0.317), but ketorolac use was associated with a 45.1 % increased risk of nonunion surgery (95 % CI 1.050–2.006, p = 0.023).

Conclusion

Ketorolac use was associated with approximately 40 % increased risk of nonunion surgery without reducing postoperative opioid use. Further research is warranted to evaluate the perioperative administration of ketorolac and other NSAIDs in humeral shaft fractures.

Level of evidence

Level III Retrospective Cohort Comparison Using Large Database Prognosis Study

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酮罗拉酸对肱骨干骨折手术治疗不愈合率的影响：一项匹配队列分析

背景：肱骨干骨折手术治疗有5 - 10%的不愈合风险。非甾体抗炎药，包括酮罗拉酸，经常用于术后疼痛治疗，但对其对骨愈合的影响一直存在担忧。虽然先前的研究表明酮罗拉酸与骨不连之间存在潜在的联系，但研究结果仍不确定。本研究旨在评估酮罗拉酸对肱骨干骨折手术治疗的成人骨不连风险的影响。方法使用ICD和CPT代码查询TriNetX研究数据库，识别接受肱骨干骨折手术固定的患者，随访至少2年。排除标准包括既往肱骨不连、病理性骨折和年龄在18岁以下。根据患者是否在术后1个月内接受了酮罗拉酸治疗，将患者分为两组。结果包括骨不连诊断、骨不连手术、阿片类药物使用、伤口并发症、浅表感染、深部感染和硬体感染。在30天、90天、1年、2年和最后随访时分析结果。结果两组术后30 d阿片类药物使用率差异无统计学意义（HR 1.051, 95% CI 0.987 ~ 1.118, p = 0.073；处方3.2±4.9 vs 3.2±5.0,p = 0.721）。然而，在1年、2年和总体随访中，接受酮罗拉酸治疗的患者显示出手术不愈合的风险显著增加。在最终随访（2.9±2.8年对3.4±3.5年）时，骨不连发生率无显著差异（4.7%对4.2%,p = 0.317），但使用酮洛酸与骨不连手术风险增加45.1%相关（95% CI 1.050-2.006, p = 0.023）。结论：酮罗拉酸的使用与术后阿片类药物使用不减少的手术不愈合风险增加约40%相关。需要进一步的研究来评估酮罗拉酸和其他非甾体抗炎药在肱骨干骨折围手术期的应用。证据水平：III级回顾性队列比较使用大数据库预后研究

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.