title: Ketorolac Administered in the Recovery Room for Acute Pain Management Does Not Affect Healing Rates of Femoral and Tibial Fractures.
abstract: OBJECTIVE
  To determine whether ketorolac administered in the immediate perioperative period affects the rate of nonunion in femoral and tibial shaft fractures.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Single Institution, Academic Level 1 Trauma Center.
  
  
  METHODS
  Three hundred and thirteen skeletally mature patients with 137 femoral shaft (OTA 32) and 191 tibial shaft (OTA 42) fractures treated with intramedullary rod fixation.
  
  
  METHODS
  Eighty patients with 33 femoral shaft and 52 tibial shaft fractures were administered ketorolac within the first 24 hours after surgery (group 1-study group). Two-hundred thirty-three patients with 104 femoral shaft and 139 tibial shaft fractures were not (group 2-control group).
  
  
  METHODS
  Rate of reoperation for repair of a nonunion and time to union.
  
  
  RESULTS
  Average time to union of the femur was 147 days for group 1 and 159 days for group 2 (P = 0.57). Average time to union of the tibia was 175 days for group 1 and 175 days for group 2 (P = 0.57). There were 3 femoral nonunions (9%) in group 1 and eleven femoral nonunions (11.6%) in group 2 (P = 1.00). There were 3 tibial nonunions (5.8%) in group 1 and 17 tibial nonunions (12.2%) in group 2 (P = 0.29). The average dose of ketorolac for patients who healed their fracture was 85 mg, whereas it was 50 mg for those who did not (P = 0.27). All patients with a nonunion in the study group were current smokers.
  
  
  CONCLUSIONS
  Ketorolac administered in the first 24 hours after fracture repair for acute pain management does not seem to have a negative impact on time to healing or incidence of nonunion for femoral or tibial shaft fractures.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopedic Surgery, University of South Florida, Tampa, FL; †Orthopedic Trauma Service, Florida Orthopedic Institute, Tampa, FL; ‡Foundation for Orthopaedic Trauma and Education, Temple Terrace, FL; §Miami Orthopaedics and Sports Medicine Institute, Miami, FL; and ‖Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: David
authors.initials: D
authors.lastname: Donohue
authors.forename: Drew
authors.initials: D
authors.lastname: Sanders
authors.forename: Rafa
authors.initials: R
authors.lastname: Serrano-Riera
authors.forename: Charles
authors.initials: C
authors.lastname: Jordan
authors.forename: Roger
authors.initials: R
authors.lastname: Gaskins
authors.forename: Roy
authors.initials: R
authors.lastname: Sanders
authors.forename: H Claude
authors.initials: HC
authors.lastname: Sagi
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D015984:Causality; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000706:statistics & numerical data*; D017102:Fracture Healing / Q000187:drug effects*; D017759:Fractures, Malunited / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000706:statistics & numerical data; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D011997:Recovery Room / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013978:Tibial Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac