McDonald Elizabeth, Winters Brian, Nicholson Kristen, Shakked Rachel, Raikin Steven, Pedowitz David I, Daniel Joseph N
1 The Rothman Institute, Philadelphia, PA, USA.
2 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Foot Ankle Int. 2018 Oct;39(10):1135-1140. doi: 10.1177/1071100718782489. Epub 2018 Jul 4.
In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures.
A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression.
In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500).
Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures.
Level IV, case series.
为尽量减少麻醉性镇痛及其潜在副作用，抗炎药物若不干扰骨折愈合，则具有巨大潜力。目前文献中，足踝手术后使用酮咯酸的安全性尚未明确界定。本研究旨在报告踝关节骨折切开复位内固定（ORIF）术后接受围手术期酮咯酸治疗方案的患者的临床愈合情况及影像学结果。
对2010年至2016年间由同一位外科医生进行外踝、双踝和三踝踝关节ORIF手术时接受围手术期酮咯酸治疗且随访至少4个月的所有患者进行回顾性研究。患者每6小时服用20片10毫克的酮咯酸。由2名经过盲法培训的足踝专科骨科医生独立评估X线片，以评估影像学愈合情况。共纳入281例患者，中位年龄51岁，男性138例（47%）。统计分析采用线性混合效应回归。
总体而言，265/281例（94%）在12周内临床愈合，261/281例（92%）在12周内影像学愈合。在12周内未愈合的患者组中，临床愈合的平均时间为16.9周（范围=14 - 25周），影像学愈合的平均时间为17.1周（范围=14 - 25周）。在服用酮咯酸的患者中，本系列未出现骨不连病例（n = 281），骨折类型与愈合或并发症之间未发现显著差异（P = 0.500）。
围手术期使用酮咯酸与12周时较高的骨折愈合率相关。这是第一项研究酮咯酸对踝关节骨折影像学愈合时间影响的研究。需要进一步研究以确定酮咯酸是否有助于减少踝关节骨折ORIF术后的阿片类药物消耗并改善疼痛情况。
IV级，病例系列。
