The Effect of Ketorolac on Bone Healing Rate Following Osteotomy in Pediatric Patients with Deformity or Limb-length Discrepancy

Background: The mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) and the results of testing in some animal fracture models have created concerns with bone healing when these drugs are used for perioperative orthopedic analgesia. Given that distraction osteogenesis patients require new bone to be formed, they would potentially be sensitive to the effects of NSAIDs such as Ketorolac. We sought to determine the relationship between the perioperative use of Ketorolac and the duration of healing in pediatric patients undergoing distraction osteogenesis for either limb lengthening or deformity correction surgery. Materials and Methods: A single-center retrospective chart review of 94 pediatric patients aged 17 years or younger who had undergone surgery for limb lengthening, deformity correction, or a combination of limb lengthening and deformity correction was carried out. We collected and analyzed patient demographics, details of surgery and pathology, perioperative pain management, duration of healing, and incidence of complications in this cohort of patients. Results: Patients were divided into three groups: a deformity correction group ( n = 46), a limb lengthening group ( n = 30), and a combined deformity correction and limb lengthening group ( n = 18). The mean magnitude of deformity was 21°. Patients in the lengthening group had a mean lengthening of 4.1 cm. Patients in the combined group had a mean magnitude of deformity of 14.7° and a mean lengthening of 3.8 cm. Patients in all three groups received an average of 4 doses of ketorolac in the perioperative period. We found no correlation between the total amount of ketorolac used and the duration of healing among patients who had deformity correction, limb lengthening, or a combination of deformity correction and limb lengthening surgery ( P = 0.82, 0.20, and 0.18, respectively). The correlation results also showed no sex variations in either group. Conclusions: Ketorolac can safely be used as an analgesic in pediatric patients undergoing distraction osteogenesis for limb lengthening, deformity correction, or a combination of both procedures.