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Complications of Ketorolac Use in Children Undergoing Operative Fracture Care

Kay, Robert M. MD*,†; Directo, Michael P. BS; Leathers, Michael BS; Myung, Karen MD, PhD*,†; Skaggs, David L. MD*,†

doi: 10.1097/BPO.0b013e3181efb8b4

Background Ketorolac is commonly used for pain relief perioperatively, but its safety is questioned in children undergoing orthopaedic surgery. The aims of this study are to evaluate the rates of osseous and soft tissue complications after operative pediatric fracture care in children treated with ketorolac, and to compare the rates to those in children treated without ketorolac.

Methods A retrospective review was conducted for 221 consecutive children who underwent operative fracture care by a single surgeon and were followed until fracture healing. Of the 221 children, 169 had received ketorolac perioperatively and 52 had not received. The children were evaluated for potential complications associated with the perioperative parenteral administration of ketorolac, specifically including nonunion, delayed union, need for transfusion, wound complications and infection.

Results There was no difference in overall complication rates between the 2 groups (P=0.928). There were 3 cases in which blood transfusion was needed, 2/169 (1.2%) in the ketorolac group and 1/52 (1.9%) in the nonketorolac group. The wound infection was comparable in the 2 groups, occurring in 1/52 (1.9%) patients in the nonketorolac group and in 4/169 (2.3%) patients in the ketorolac group. There were no cases of delayed union or nonunion in either group.

Conclusions The results of this study indicate that perioperative ketorolac use does not increase the risk of complications after operative fracture care in children (P=0.928). Specifically, there was no increased risk with regard to infection or wound complications, and there were no cases of delayed union or nonunion.

Level of Evidence Level III.

*Childrens Orthopaedic Center, Children's Hospital Los Angeles

Keck-University of Southern California School of Medicine, Los Angeles, CA

Michael Directo received financial support from the Keck-University of Southern California School of Medicine to conduct this research. No other author received funding for this research.

Reprints: Robert M. Kay, MD, Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027. e-mail:

Study Conducted at Children's Hospital Los Angeles, Los Angeles, CA.

© 2010 Lippincott Williams & Wilkins, Inc.