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Postoperative Ketorolac Use and the Odds of a Nonunion in Operatively Treated Metacarpal Fractures
Madison A. Oxford
*, Christopher Fullmer
1, John Roberts
Department of Surgery, Division of Plastic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
Background: The use of ketorolac, a potent nonsteroidal anti-inflammatory drug (NSAID), has been largely avoided by hand surgeons following operative repair of fractures given concern for an increased risk of nonunion. Recent studies looking at scaphoid and distal radius fractures have demonstrated equivalent bone healing outcomes with and without short courses of NSAIDs. We sought to determine if postoperative ketorolac administration within five days of operative treatment for metacarpal fractures would show an increased rate of nonunion or revision surgery.
Methods: A retrospective cohort study was performed using the TriNetX database. Adult patients who underwent operative treatment of a metacarpal fracture from 2015 to 2025 were included. Cohorts were defined based on postoperative ketorolac use within five days of the index surgery. After propensity score matching, incidence of nonunion and nonunion revision surgery within six months of the index surgery was determined and compared with odds ratios (ORs) and 95% CIs. Statistical significance was reported as an alpha error of < 0.05.
Results: A total of 12,822 matched patients (6,411 ketorolac; 6,411 no ketorolac) were compared. There was not a significant difference in nonunion rate or nonunion revision surgery rate between the ketorolac and the no ketorolac groups (2.23% vs 2.24%; OR, 0.993 [95% CI, 0.786, 1.255] and 0.78% vs 1.08%; OR, 0.722 [95% CI, 0.501, 1.041]).
Conclusion: Postoperative ketorolac use within five days of operative treatment of metacarpal fractures does not significantly increase the rate of nonunion or nonunion revision surgery. This contributes to the growing evidence that short courses of postoperative ketorolac may be safely used in the ambulatory hand surgery setting.
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