Ashley A Ellingwood, Daniel Woo, Richard E Campbell, Christopher D Souder, Patrick F Curran, James D Bomar, Rachel M Thompson
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引用次数: 0
Abstract
Background: Ketorolac is a common component of multimodal analgesia protocols; however, there are concerns that it may increase the risk of pediatric fracture nonunion, particularly in femoral shaft fractures. The purpose of this study was to determine whether perioperative ketorolac administration is associated with an increased risk of nonunion in operatively treated pediatric femoral shaft fractures.
Methods: We conducted an IRB-approved retrospective review of all pediatric patients (age <18 y) who underwent operative management of femoral shaft fractures at a single institution between May 1, 2012, and December 31, 2024. Patients aged ≥18 years, those treated nonoperatively, with underlying bone pathology, inadequate follow-up, or nondiaphyseal fractures were excluded. The primary outcome was radiographic nonunion, determined by the Radiographic Union Scale for Tibia score and treating surgeon documentation. Secondary outcomes included postoperative opioid consumption, pain scores, and hospital length of stay.
Results: Nonunion was rare in this cohort, occurring in 1/122 patients (0.8%) who received ketorolac and 1/21 patients (4.8%) who did not receive ketorolac (P=0.27). Patients who received ketorolac required fewer opioids, averaging 0.13±0.17 (95% CI 0.10-0.16) versus 0.23±0.28 (95% CI 0.10-0.35) MME/kg in the first 24 hours postoperatively (P=0.047) and 0.44±0.84 (95% CI 0.29-0.59) versus 3.98±6.57 (95% CI 0.99-6.97) MME/kg cumulatively throughout admission (P<0.001). Pain scores did not differ significantly between the ketorolac and no-ketorolac groups in the first 24 hours (P=0.30) or cumulatively (P=0.50).
Conclusions: This comparative case series demonstrates that nonunion in operatively treated pediatric femoral fractures is rare regardless of ketorolac administration. In addition, ketorolac use appears to be associated with reduced opioid requirements without increasing pain scores.
背景：酮罗拉酸是多模式镇痛方案的常见成分；然而，人们担心它可能会增加儿童骨折不愈合的风险，特别是在股骨干骨折中。本研究的目的是确定围手术期使用酮罗拉酸是否与手术治疗的儿童股骨干骨折不愈合风险增加有关。方法：我们对所有儿科患者（年龄）进行了irb批准的回顾性研究。结果：该队列中骨不连很罕见，接受酮罗拉酸治疗的患者中有1/122例（0.8%）发生骨不连，未接受酮罗拉酸治疗的患者中有1/21例（4.8%）发生骨不连（P=0.27）。接受酮洛酸治疗的患者需要较少的阿片类药物，术后24小时平均0.13±0.17 （95% CI 0.10-0.16）比0.23±0.28 (95% CI 0.10-0.35) MME/kg (P=0.047)，入院期间累计0.44±0.84 （95% CI 0.29-0.59）比3.98±6.57 (95% CI 0.99-6.97) MME/kg(结论：该比较病例系列表明，无论给予酮洛酸治疗，手术治疗的儿童股骨骨折不愈合是罕见的。此外，酮咯酸的使用似乎与阿片类药物需求的减少有关，而不会增加疼痛评分。证据等级：iii级——治疗性研究。
期刊介绍：
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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