Background: Nonunion is a significant complication following scaphoid fractures. Although ketorolac has been linked to impaired bone healing in other fracture types, its specific impact on scaphoid healing remains unclear. This study aimed to evaluate the association between postoperative ketorolac use and the risk of nonunion after scaphoid fractures.

Methods: The TriNetX database was used to identify patients who underwent surgical repair of scaphoid fractures. Patients were categorized into ketorolac-exposed and unexposed cohorts. A 1:1 propensity score matching was conducted to adjust for potential confounding factors associated with nonunion. The primary outcome was the incidence of nonunion at 6, 9, and 12 months postoperatively. Subgroup analyses were performed based on fracture location: proximal third, middle third, and distal pole.

Results: After matching, 7,049 patients were included in each cohort. At 6 months, ketorolac use within 30 days postoperatively was associated with a significantly higher risk of nonunion compared to the control group (risk ratio [RR] 1.39; 95% CI, 1.27–1.54; p<0.001). Subgroup analyses demonstrated similarly elevated risks for proximal third (RR 2.13; 95% CI, 1.61–2.81; p<0.001), middle third (RR 1.38; 95% CI, 1.20–1.60; p<0.001), and distal pole fractures (RR 2.11; 95% CI, 1.21–3.69; p=0.007). These associations remained significant at 9 and 12 months.

Conclusions: Postoperative ketorolac use is associated with a significantly increased risk of nonunion following scaphoid fracture repair, across all anatomical subtypes. These findings highlight the need for cautious use of ketorolac in patients undergoing scaphoid fracture treatment.