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Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis
CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793548/ http://dx.doi.org/10.1177/2473011421S00269 |
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author | Kachooei, Amir R. Hester, William Gaston, Tara Corr, Daniel O. Daniel, Joseph N. |
author_facet | Kachooei, Amir R. Hester, William Gaston, Tara Corr, Daniel O. Daniel, Joseph N. |
author_sort | Kachooei, Amir R. |
collection | PubMed |
description | CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (MTP) joint arthrodesis and five-day ketorolac administration. We secondarily aimed to compare the observed rate of nonunion in our study with the reported rate of 5.4% in a systematic review. METHODS: In a retrospective cohort study, we included 181 primary MTP arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. Ketorolac was administered every 6 hours for five consecutive days postoperative. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at three months and the final follow- up. Nonunion was categorized as symptomatic versus asymptomatic. RESULTS: At three months postoperative, patient characteristics did not show any statistically significant difference between union and nonunion groups. However, at the final follow-up, hallux rigidus was significantly associated with a higher rate of the union in comparison to the preexisting hallux valgus deformity (odds=3.7; P=0.04). of 181 feet, 15 (8.3%) at three months and 12 (6.6%) at the final follow-up revealed nonunion. Of 15, 7 (45%) were asymptomatic, and 8 (55%) were symptomatic. Six (75%) of the 'symptomatic' nonunion underwent an unplanned secondary surgery. Almost 50% of the asymptomatic nonunions at three months healed by the final follow-up; however, none of the symptomatic nonunions healed. Comparing the observed proportion of nonunions at three months (8.3%) and the final follow-up (6.6%) in our study to the mean nonunion rate of 5.4% found in the literature revealed no significant difference between our results and the literature (P=0.067 and 0.27, respectively). CONCLUSION: A short course of oral ketorolac does not seem to affect the union rate after MTP arthrodesis. Ketorolac can be used safely and effectively to decrease postoperative opioid consumption. |
format | Online Article Text |
id | pubmed-8793548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-87935482022-01-28 Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis Kachooei, Amir R. Hester, William Gaston, Tara Corr, Daniel O. Daniel, Joseph N. Foot Ankle Orthop Article CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (MTP) joint arthrodesis and five-day ketorolac administration. We secondarily aimed to compare the observed rate of nonunion in our study with the reported rate of 5.4% in a systematic review. METHODS: In a retrospective cohort study, we included 181 primary MTP arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. Ketorolac was administered every 6 hours for five consecutive days postoperative. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at three months and the final follow- up. Nonunion was categorized as symptomatic versus asymptomatic. RESULTS: At three months postoperative, patient characteristics did not show any statistically significant difference between union and nonunion groups. However, at the final follow-up, hallux rigidus was significantly associated with a higher rate of the union in comparison to the preexisting hallux valgus deformity (odds=3.7; P=0.04). of 181 feet, 15 (8.3%) at three months and 12 (6.6%) at the final follow-up revealed nonunion. Of 15, 7 (45%) were asymptomatic, and 8 (55%) were symptomatic. Six (75%) of the 'symptomatic' nonunion underwent an unplanned secondary surgery. Almost 50% of the asymptomatic nonunions at three months healed by the final follow-up; however, none of the symptomatic nonunions healed. Comparing the observed proportion of nonunions at three months (8.3%) and the final follow-up (6.6%) in our study to the mean nonunion rate of 5.4% found in the literature revealed no significant difference between our results and the literature (P=0.067 and 0.27, respectively). CONCLUSION: A short course of oral ketorolac does not seem to affect the union rate after MTP arthrodesis. Ketorolac can be used safely and effectively to decrease postoperative opioid consumption. SAGE Publications 2022-01-21 /pmc/articles/PMC8793548/ http://dx.doi.org/10.1177/2473011421S00269 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Kachooei, Amir R. Hester, William Gaston, Tara Corr, Daniel O. Daniel, Joseph N. Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title | Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title_full | Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title_fullStr | Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title_full_unstemmed | Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title_short | Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis |
title_sort | effect of postoperative ketorolac administration on the union rate following first metatarsophalangeal joint arthrodesis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793548/ http://dx.doi.org/10.1177/2473011421S00269 |
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