scholarly journals Factors associated with persistent opioid use after an upper extremity fracture

2021 ◽  
Vol 2 (2) ◽  
pp. 119-124
Author(s):  
Romil Fenil Shah ◽  
Stephen E. Gwilym ◽  
Sarah Lamb ◽  
Mark Williams ◽  
David Ring ◽  
...  
Keyword(s):  
Social Support ◽  
Upper Limb ◽  
Emotional Health ◽  
Instrumental Support ◽  
Opioid Use ◽  
Post Injury ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Limb Fracture ◽  
Upper Limb Fracture

Aims The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. Cite this article: Bone Jt Open 2021;2(2):119–124.

Therapeutic Functional Bracing in Upper Limb Fracture-Dislocations

1988 ◽  
Vol 2 (4) ◽  
pp. 308-313 ◽  
Author(s):  
K. S. Leung ◽  
M. Kwan ◽  
J. Wong ◽  
W. Y. Shen ◽  
A. Tsang
Keyword(s):  
Upper Limb ◽  
Limb Fracture ◽  
Fracture Dislocations ◽  
Upper Limb Fracture

scholarly journals Neurological status documentation in upper limb fracture patients

Injury Extra ◽  
2011 ◽  
Vol 42 (9) ◽  
pp. 122
Author(s):  
E.S. Uppin ◽  
A. Khurana ◽  
U.K. Choudhuri ◽  
R. Trickett
Keyword(s):  
Upper Limb ◽  
Neurological Status ◽  
Limb Fracture ◽  
Upper Limb Fracture

Coping with an upper limb fracture? A study of the elderly

Public Health ◽  
1992 ◽  
Vol 106 (1) ◽  
pp. 19-28 ◽  
Author(s):  
R. Madhok ◽  
R.S. Bhopal
Keyword(s):  
Upper Limb ◽  
The Elderly ◽  
Limb Fracture ◽  
Upper Limb Fracture

Low volumetric BMD is linked to upper-limb fracture in pubertal girls and persists into adulthood: A seven-year cohort study

Bone ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 480-486 ◽  
Author(s):  
Sulin Cheng ◽  
Leiting Xu ◽  
Patrick H.F. Nicholson ◽  
Frances Tylavsky ◽  
Arja Lyytikäinen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Upper Limb ◽  
Limb Fracture ◽  
Volumetric Bmd ◽  
Upper Limb Fracture

scholarly journals Management of post-traumatic stiffness of the shoulder following upper limb trauma with manipulation under anaesthetic

2017 ◽  
Vol 9 (4) ◽  
pp. 258-265 ◽  
Author(s):  
Sarah T. Lancaster ◽  
Thomas N. Grove ◽  
David A. Woods
Keyword(s):  
Upper Limb ◽  
Frozen Shoulder ◽  
Standard Technique ◽  
Humeral Fracture ◽  
Limb Fracture ◽  
Significant Difference ◽  
Shoulder Scores ◽  
Post Traumatic ◽  
Upper Limb Fracture ◽  
Limb Fractures

Background A proportion of patients who sustain upper limb fractures develop post-traumatic stiffness (PTS), which may progress in a similar way to primary frozen shoulder (PFS). We have had success in treating PFS with manipulation under anaesthetic (MUA) and therefore treated PTS using MUA. Oxford Shoulder Scores (OSS), range of motion (ROM) data pre- and post-MUA, and the need for repeat procedure were compared. Methods Sixty-four patients with PTS following an upper limb fracture, unresponsive to conservative measures, were seen between 1 January 1999 and 1 November 2015. Thirty-two patients had sustained a proximal humeral fracture, six of whom had a concurrent shoulder dislocation. MUA was performed using a standard technique. The results were compared with 487 PFS patients undergoing the same procedure. Results There was no significant difference in ROM change between the groups. Improvement in OSS was slightly greater in the PFS group (17 versus 14, p = 0.005) but, upon subgroup analysis of the PTS group, no significant difference was found for patients presenting with humeral fractures alone. Conclusions MUA results for PTS following upper limb fracture are comparable to MUA for PFS. We therefore recommend MUA in PTS cases where conservative methods have failed.

scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk

Injury ◽  
2016 ◽  
Vol 47 (8) ◽  
pp. 1835-1840 ◽  
Author(s):  
Marianne Jodoin ◽  
Dominique M. Rouleau ◽  
Camille Charlebois-Plante ◽  
Benoit Benoit ◽  
Stéphane Leduc ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
At Risk ◽  
Brain Injury ◽  
Incidence Rate ◽  
Mild Traumatic Brain Injury ◽  
Upper Limb ◽  
Limb Fracture ◽  
Upper Limb Fracture

scholarly journals Conventional Ankle Sprain Treatment is Associated with Alarmingly High Rates of Persistent Opioid Use

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Fred T. Finney ◽  
Timothy D. Gossett ◽  
Hsou Mei Hu ◽  
Jennifer Waljee ◽  
Chad Brummett ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Household Income ◽  
Nonoperative Treatment ◽  
Patient Specific ◽  
Ankle Sprains ◽  
Median Household Income ◽  
Opioid Use ◽  
Patient Factors ◽  
Opioid Prescription ◽  
Factors Associated

Category: Ankle Introduction/Purpose: The opioid epidemic has been defined by over-prescribing by practitioners and increasing misuse, abuse, and diversion of opioids by patients. Orthopedic surgeons are the fourth largest prescriber of opioid medications and have a unique opportunity to play a prominent role in the solution. Many perceived barriers to such a solution have now been eliminated. For example, it has been demonstrated that neither the amount nor duration of opioid prescription correlates with patient satisfaction. To address this epidemic, it is important to first understand rates of new persistent opioid use following specific injuries and to identify patient-specific risk factors. In this study, we evaluated new persistent opioid use following nonoperatively treated ankle sprains, one of the most common orthopaedic injuries seen in any healthcare system. Methods: A widely accepted insurance claims database was used to identify patients who underwent nonoperative treatment of an ankle sprain between January 2008 and December 2016. None had an opioid prescription filled in the period of 12 months to 7 days prior to treatment (defined as “opioid naïve”). We evaluated peri-treatment and post-treatment opioid prescription fulfillment to analyze prescribing patterns and continuation of opioid use. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after treatment. Logistic regression analysis was used to evaluate the effect of patient factors, including age, gender, median household income, tobacco use, mental health and pain disorders, and medical comorbidities on the likelihood of new persistent use. Results: 42,445 patients were identified who underwent nonoperative treatment of an ankle sprain and received an opioid prescription. The overall rate of new persistent opioid used following nonoperative treatment of ankle sprains was 9.3%. Rates of continued opioid use were significantly increased among patients who received an opioid dose prescribed in the peri-treatment period that was in the top 25th percentile of total oral morphine equivalents. In addition, patient-specific factors which were associated with new persistent opioid use included female gender, tobacco use, certain mental health disorders, comorbid conditions, and pre-existing arthritis. Patient factors associated with lower rates of new persistent opioid use included higher level education and median household income of $100,000 or more. Conclusion: Chronic opioid use is a major problem, even in the setting of relatively minor musculoskeletal injuries. Defining the problem and understanding contributing factors to this epidemic are paramount to developing a solution. Ankle sprains represent an orthopaedic injury which does not warrant opioid use for pain control. In this series, an alarming number of patients who sustained an ankle sprain were treated with an opioid medication, and 9.3% of these patients continued opioid use after three months. Understanding the risk factors associated with this problem provides a foundation upon which to address this sometimes lethal, public health problem.

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