BACKGROUND Nonunion is a rare yet serious complication in pediatric fracture healing that can lead to patient morbidity and economic burden. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of fracture nonunion in adults, but data are lacking in the pediatric population. This study examines the relationship between postoperative ketorolac administration and nonunion in operatively managed pediatric long-bone fractures. METHODS A retrospective cohort study was conducted with use of TriNetX, a research network that encompasses data from the United States, Canada, and Western Europe. A total of 462,260 patients from 52 health-care organizations met the inclusion criteria. Patients <18 years old with operatively managed upper or lower-extremity long-bone fractures were included. The exposure of interest was ketorolac administration within 30 days postoperatively between 2003 and 2023. Nonunion was identified and verified with use of the pertinent medical codes. Absolute risks and hazard ratios (HRs) were calculated for both study groups. Significance was set at p < 0.05. RESULTS After propensity score matching, 48,778 patients were identified per group. The incidence of nonunion was 2.19% in the ketorolac group and 0.93% in the non-ketorolac group (HR, 2.71; 95% confidence interval [CI]: 2.46, 3.21; p < 0.0001). Subgroup analyses demonstrated a higher risk of nonunion in patients with lower-extremity fractures (HR, 3.45; 95% CI: 3.14, 3.75; p < 0.0001) than in those with upper-extremity fractures (HR, 2.11; 95% CI: 1.84, 2.32; p < 0.0001). Among the fracture location subgroups, the greatest HR for nonunion was observed in patients with femoral fractures, followed sequentially by those with tibial and/or fibular fractures, humeral fractures, and radial and/or ulnar fractures. CONCLUSIONS To our knowledge, this is the largest study to date to explore postoperative ketorolac use and nonunion in the setting of operatively managed pediatric long-bone fractures. Nonunion in children was rare, occurring in <1% of all included patients. Ketorolac administration was associated with a 2 to 3-fold increase in nonunion risks, with pronounced implications for patients with lower-extremity fractures, particularly those with femoral fractures. Clinicians should weigh the therapeutic advantages of non-opiate analgesia with ketorolac against the risk of nonunion in order to optimize postoperative pain management and recovery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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酮咯酸给药对手术治疗的小儿长骨骨折不愈合率的影响：匹配的队列分析。


背景 骨不连是小儿骨折愈合中一种罕见但严重的并发症，可导致患者发病率和经济负担。非甾体抗炎药 （NSAIDs） 的给药与成人骨折不愈合的风险增加有关，但缺乏儿科人群的数据。本研究检查了术后酮咯酸给药与手术治疗的小儿长骨骨折不愈合之间的关系。方法 使用 TriNetX 进行了一项回顾性队列研究，TriNetX 是一个包含来自美国、加拿大和西欧的数据的研究网络。来自 462,260 个医疗保健机构的 52 名患者符合纳入标准。纳入手术治疗的上肢或下肢长骨骨折患者 <18 岁。感兴趣的暴露是 2003 年至 2023 年术后 30 天内酮咯酸给药。使用相关医疗代码识别和验证了 Nonunion。计算两个研究组的绝对风险和风险比 （HRs）。显著性设置为 p < 0.05。结果 倾向评分匹配后，每组确定 48,778 例患者。酮咯酸组骨不连的发生率为 2.19%，非酮咯酸组为 0.93% （HR，2.71;95% 置信区间 [CI]：2.46,3.21;p < 0.0001）。亚组分析显示，下肢骨折患者骨不连的风险更高 （HR， 3.45;95% CI： 3.14， 3.75;p < 0.0001） 高于上肢骨折患者 （HR， 2.11;95% CI： 1.84， 2.32;p < 0.0001）。 在骨折位置亚组中，股骨骨折患者骨不连的 HR 最大，其次是胫骨和/或腓骨骨折、肱骨骨折以及桡骨和/或尺骨骨折患者。结论 据我们所知，这是迄今为止最大的研究，旨在探讨手术治疗的小儿长骨骨折情况下酮咯酸的使用和骨不连。儿童骨不连很少见，在所有纳入的患者中发生 <1%。酮咯酸给药与骨不连风险增加 2 至 3 倍相关，对下肢骨折患者，尤其是股骨骨折患者有显著影响。临床医生应权衡酮咯酸非阿片类镇痛的治疗优势与骨不连的风险，以优化术后疼痛管理和恢复。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。