Ketorolac Administered in the Recovery Room for Acute Pain Management Does Not Affect Healing Rates of Femoral and Tibial Fractures

Donohue, David; Sanders, Drew; Serrano-Riera, Rafa; Jordan, Charles J.; Gaskins, Roger B.; Sanders, Roy; Sagi, H. Claude

doi:10.1097/bot.0000000000000620

Cited by 28 publications

(21 citation statements)

References 28 publications

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“…Likewise, Giannoudis et al 30 suggested a significant association of poor bone healing outcomes with ibuprofen/diclofenac exposure, for a mean duration of 21.2 weeks, during the postoperative period (p < 0.00001). In contrast, Donohue et al 64 reported no increased risk of complications with the use of standard-dose IV/IM ketorolac for 24 h in the immediate post-operative period. Although the results were not statistically significant (p ¼ 0.25), the reported narrow confidence interval (OR ¼ 0.58, 95% CI 0.23-1.46) highlights them as accurate and relevant within clinical settings (Table 4).…”

Section: Resultsmentioning

confidence: 93%

“…Reuben and Ekman 56 Randomised trial Fraudulent allegations reported in literature 69 11 retrospective cohort studies, 37,39,41,42,44,45,[62][63][64][65][66] two case-control studies 30,67 and two prospective randomised trials 40,46 ( Tables 2 and 3) that underwent qualitative analysis, of which eight retrospective cohort studies 37,39,41,42,44,45,62,64 and two case-control studies 30,67 on adult populations formed part of the meta-analysis. Table 4 shows the abstraction data and statistical parameters for all analysed studies.…”

Section: Resultsmentioning

confidence: 99%

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Effects of NSAID use on bone healing: A meta-analysis of retrospective case–control and cohort studies within clinical settings

Ali

Usman

Patel

2019

Trauma

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Introduction This meta-analysis aims to determine whether non-steroidal anti-inflammatory drug (NSAID) use is significantly associated with adverse bone healing outcomes within clinical settings, including trauma and elective spine settings. It will also explore bone healing outcomes with the type, route, dosage and duration of NSAID exposure and aims to demonstrate the effects of various other confounding factors on bone healing outcomes. Methods Electronic databases including MedLine, Embase and Cochrane were searched from January 1975 to December 2017. A distinct analysis of observational long bone and spine studies in adult populations was performed, assessing the effects of NSAID exposure on bone healing. Studies from paediatric population and randomised trials also underwent separate assessment in the synthesis. Meta-analysis was conducted in compliance with QUORUM and PRISMA guidelines. Results Quantitative assessment of observational studies suggested a significant risk of bone healing complications with NSAID exposure across each clinical group: long bone (p = 0.0004) and spine (p = 0.02). Analysis of paediatric studies revealed a non-significant association of poor outcomes with NSAID use (p = 0.36), while assessment of randomised trials demonstrated a statistically significant risk of complications following NSAID administration (p = 0.04). Meta-regression further suggested smoking to be a substantial confounder associated with adverse bone healing outcomes (p < 0.00001). Conclusion Inclusion of only fair and moderate-quality retrospective cohort and case–control studies in the current synthesis limits the clinical application of its findings and therefore warrants the need for further research. Thus, attempts to conduct high-quality prospective cohort and randomised trials to study the effects of NSAID use on bone healing would be very helpful and will provide a basis for more extensive research in future.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Effects of NSAID use on bone healing: A meta-analysis of retrospective case–control and cohort studies within clinical settings

Ali

Usman

Patel

2019

Trauma

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“…Long-term use of NSAIDs and the severity of concomitant injuries may both have a negative effect on bone healing due to interference in the acute inflammation stage of fracture healing. [7] We used the administration of analgesics for more than 3 consecutive months and admission of more than 2 weeks as risk factors representing concomitant or more severe injuries. The results revealed no significance over the three risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…The radiographic part was defined as when no visible progressive signs of healing were identified for at least 3 consecutive months, when the fractured bone had not healed within 9 months, or if the orthopaedic surgeon considered the fracture to have little or no chance of healing. [7] The clinical part was defined as persistent pain and soreness feeling of the thigh during walk.…”

Section: Methodsmentioning

confidence: 99%

“…[5] Open fractures, tobacco use, delayed weight bearing, comminution of the fracture site, instability of fracture reduction, nonsteroidal anti-inflammatory drugs may intervene in fracture healing and inadequate choice of nail diameter were reported as the risk factors of nonunion of femur shaft fracture. [6,7] Weresh et al revealed that age and the nail locking technique were identified as being very strongly associated to propensity of healing. [8] Therefore, it is critical to understand fracture union in middle age patients because this will lead to positive clinical outcomes and early back to work.…”

Section: Introductionmentioning

confidence: 99%

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The risk factors of nonunion after intramedullary nailing fixation of femur shaft fracture in middle age patients

Yeh

et al. 2019

Medicine

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Although the optimal treatment for femur shaft fracture is intramedullary nailing fixation, nonunion still occurs. We determined the oligotrophic nonunion rate among femur fractures managed operatively and identified risk factors for reoperation. This was a retrospective clinical study. The data of the patients between 40 and 70 years old with diaphyseal femur fracture who have received reamed and interlocked intramedullary nailing fixation in our hospital from February 2014 to April 2018 were collected. They were followed at regular intervals for at least 1 year after the operation. The primary outcome was nonunion of the fracture site that required reoperation in accordance with the radiographic union scale for tibial shaft fracture (RUST), which is a reasonable score system for lower limb diaphyseal fracture. Three of them were hypertrophic nonunion (1.9%) and the other 13 cases were oligotrophic nonunion (8.6%) at postoperative 12 months follow-up. All of the postoperative plain films showed adequate reduction quality. The three hypertrophic nonunion cases were all obese male with fracture site comminution. Fracture at the proximal third junction, hypertension (HTN) and diabetes mellitus (DM) was significantly associated with oligotrophic nonunion of the fracture site from logistic regression analysis. The mean RUST score 3 months after the operation was not significantly different between the union group and nonunion group but was significantly lower 6 months after the operation in the nonunion group. In conclusion, intramedullary nailing of the femur shaft fractures was associated with a low risk of nonunion at the 1-year follow-up in the middle age group. Those with comorbidity such as obese, HTN, and DM, with fracture site at the proximal third junction or comminution should be followed up closely and rehabilitation with cause aggressively. Radiographic scale as the RUST score at postoperative 6 months could be used to predict this complication.

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NSAID use in orthopedic surgery: A review of current evidence and clinical practice guidelines

Ryan,

Scherry,

Pierson

et al. 2024

Journal Orthopaedic Research

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Nonsteroidal anti‐inflammatory drugs (NSAIDs) are a valuable class of medications for orthopedic surgeons and often play a pivotal role in pain control. However, there are many common stipulations resulting in avoidance of its use in the treatment of musculoskeletal disease. This review summarizes the mechanism of action of NSAIDs as well as provides an overview of commonly used NSAIDs and the differences between them. It provides a concise summary on the osseous effects of NSAIDs with regard to bone healing and heterotopic ossification. Most of all, it serves as a guide or reference for orthopedic providers when counseling patients on the risks and benefits of NSAID use, as it addresses the common stipulations encountered: “It irritates my stomach,” “I have a history of bariatric surgery,” “I'm already on a blood thinner,” “I've had a heart attack,” and “I've got kidney problems” and synthesizes both current research and society recommendations regarding safe use and avoidance of NSAIDs.

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Ketorolac Administered in the Recovery Room for Acute Pain Management Does Not Affect Healing Rates of Femoral and Tibial Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 28 publications

References 28 publications

Effects of NSAID use on bone healing: A meta-analysis of retrospective case–control and cohort studies within clinical settings

Effects of NSAID use on bone healing: A meta-analysis of retrospective case–control and cohort studies within clinical settings

The risk factors of nonunion after intramedullary nailing fixation of femur shaft fracture in middle age patients

NSAID use in orthopedic surgery: A review of current evidence and clinical practice guidelines

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