52 patients with an extremity fracture and scheduled for fixation were randomized to postoperative analgesia with acetaminophen with or without tramadol. The purpose of this study was to determine if acetaminophen alone provided noninferior analgesia to the combination of acetaminophen and tramadol. At 2 week follow-up, noninferiority was observed in assessments of current pain and satisfaction, though noninferiority could not be established in the assessment of worst pain since surgery. Two patients managed with acetaminophen alone required rescue analgesia.