Ketorolac Effects on Post-operative Pain and Bone Healing

Inclusion Criteria:

- Hallux abductus with bunion deformity

- Adult patients as defined by >=18 years old and <= 65 years old

- Subject has adequate perfusion, verified by the surgeon, which is defined by palpable
pedal pulses

- Subject has voluntarily signed and dated an informed consent form, approved by IRB,
and provided HIPAA (or other applicable privacy regulation) authorization prior to any
participation in the study

- Subject agrees not to take any new medications, dietary supplements, or alternative
therapies during the study period (approximately 12 weeks)

- Subject is interested in participating in the study and willing to comply with the
study protocol

- Patient has pain related to a bunion deformity but pain-free metatarsalphalangeal
joint (MTPJ) range of motion that is not functionally adapted

- Adequate bone density to withstand a Kalish bunionectomy procedure

- No frontal plane hallux deformity

- Minimal abnormality of the PASA

- Normal to minimally malaligned sagittal plane position of the first metatarsal

- Failure of conservative treatment

- General Pre-operative Radiographic Angle Criteria† - 10-15 degree IMA in rectus feet*
- 20-25 degree TAA in adducted feet* - 15-20 degree IMA in rectus feet if wide
metatarsal head width - 25-30 degree TAA in adducted feet if wide metatarsal head
width IMA=intermetatarsal angle; TAA=total adductus angle *If the pre-operative IMA is
<15 degree, only the IMA will be used pre-operatively. For IMA >=15, the total
adductus angle will be used †These are general guidelines and the width of the
metatarsal as well as the presence of positional, structural, or combined first ray
deformity may also influence procedure selection.

Exclusion Criteria:

- a history of an allergic-type reaction in response to exposure to aspirin,
phenylacetic acid derivatives, or other NSAIDs

- hypersensitivity to ketorolac tromethamine, or to any product component

- any known bleeding risk or bleeding disorder, suspected or confirmed

- history of or active cerebrovascular bleeding, suspected or confirmed

- concomitant aspirin or NSAID use where the patient may not be advised to discontinue
the medication during the study

- concomitant pentoxifylline use

- concomitant probenecid use

- coronary artery bypass graft (CABG) surgery within one year of the procedure

- any history of gastrointestinal bleeding/perforation, gastrointestinal ulcer, severe
peptic ulcer disease, or severe inflammatory bowel disease

- hemorrhagic diathesis, suspected or confirmed

- incomplete intraoperative hemostasis

- pre-operative serum creatinine > 1.5 ml/dL or blood urea nitrogen level > 22 mg/dL

- any history of renal impairment or risk of renal failure due to volume depletion

- Patients with a known allergy, contraindication and/or intolerance for oxycodone
5mg - acetaminophen 325 mg will be excluded from the study.

- Patients with a known allergy, contraindication, and/or intolerance for the local
anesthetic (bupivicaine) or any of the standardized intra-operative opioids and
anti-emetics administered by the anesthesiologist

- Patients with a history of fibromyalgia or opioid abuse

- History of chronic regional pain syndrome or diagnosis of any chronic pain
syndrome, patients requiring routine methadone or other opioids

- Neuropathy or radiculopathy

- Subject has alcohol or substance abuse, dementia, brain metastases, or other
cognitive disorders that may interfere with pain assessment and the
post-operative course outlined by the surgeon

- American Society of Anesthesiologists (ASA) Physical Status class four or higher

- women who are pregnant, planning on becoming pregnant, or breast feeding

- presence of active local or systemic infection

- subject has a myocardial infarction in the last twelve months

• Patients who are not candidates for a Kalish bunionectomy due to the preoperative
deformity as well as other study exclusions are:

- Absent pedal pulses or ABI < 0.9 and > 1.2

- Concomitant midfoot and rearfoot procedures

- Moderate to high abnormal PASA angles

- Significant sagittal plane first metatarsal deformity

- Moderate to severe osteoporosis as evaluated by preoperative radiographs and/or bone
mineral density tests

- Revision cases

- History of previous infections, radiation treatment, or current infection related to
the surgical site

- History of previous trauma of the first metatarsal or first ray

- Subject has known immunosuppression (HIV, recent chemotherapy, organ transplant)

- Patients taking systemic steroid (patients taking less than 5 mg of prednisone,
inhaled steroids for asthma or chronic obstructive pulmonary disease, topical or
optical steroids will not be excluded)

- Subject has active malignancy, excluding cutaneous malignancies except melanoma
Pregnancy Elective bunion surgery will not be performed if the patient is pregnant or
planning on becoming pregnant during this study.