SLR - November 2017 - Adam J. Oxios

Effect of Postoperative Toradol Administration on Bone Healing After Ankle Fracture Fixation

Reference: McDonald E, Winters B, Shakked R, Pedowitz D, Raikin S, Daniel J. Effect of Postoperative Toradol Administration on Bone Healing After Ankle Fracture Fixation. Foot and Ankle Orthopedics. 2017 Oct 14;2(3).

Scientific Literature Review

Reviewed By: Adam J. Oxios, DPM
Residency Program: Westside Regional Medical Center, Plantation, FL

Podiatric Relevance: Adverse effects to narcotic analgesics is commonly seen in the world of surgery. Many times, a surgeon must prescribe a medication that provides the same pain scale coverage without exposure to the narcotic. Toradol is a drug commonly used; however, hesitation exists among doctors due to the notion that Toradol decreases bone healing properties. Is this really the case?


  • Retrospective chart review on patients who received perioperative ketorolac at the time single, bi- or trimalleolar ankle ORIF. Patients were then prescribed ketorolac 10 mg PO q6h x five days. Radiographs were analyzed to assess for radiographic healing of the malleoli at six, 12 and 16 weeks postoperatively. Literature review was performed to determine an appropriate control of time to radiographic healing after ankle ORIF for comparison.
  • 294 patients (47 percent male, 53 percent female), average age of 50 years

Results: Radiographic healing was demonstrated in greater than 80 percent of fractures by 16 weeks. There was no significant difference in healing times between this group and the control group, which averaged 16.7 weeks until full union.

Significant relationships were seen between active tobacco use and delayed healing time. A positive relationship was also seen between patients living with diabetes as well as patients more than 50 years of age and increased healing time. RA and steroid use had no effect of time until radiographic healing.  

Conclusions: Use of perioperative ketorolac did not affect time until radiographic healing for ankle fractures after ORIF. As expected, active tobacco use was associated with delayed healing time. Although a relatively large sample size was used, it was surprising to see increased healing time in the elderly (>50) population living with diabetes. This contradicts past literature on the subject and may indicate a skewed sample was used for analysis. Otherwise, one would need to believe there was a beneficial impact of ketorolac on bone healing in those two populations. The subject warrants further study.

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