Factors Associated With Narcotic Use After Clavicle Fractures

Abstract

Clavicle fractures are common in adults. Recent studies have shown that operative treatment of clavicle fractures has benefits in many situations. However, there is controversy about the indications. Data on social outcomes are limited. A total of 434 patients with 436 clavicle fractures treated both operatively and nonoperatively at a level 1 trauma center were identified. Narcotic use was recorded 2, 4, 6, 8, 10, 12, 14, and 16 weeks after injury for both treatment groups. Other descriptive data included age, sex, laterality, hand dominance, rib fractures, smoking, alcohol use, employment, long bone or spine fracture, open clavicle fracture, and mechanism of injury. Logistic regression analysis was performed to determine the independent predictors of narcotic use after clavicle fracture. Open reduction and internal fixation was performed in 105 fractures (24%), and 329 fractures were managed nonoperatively. A total of 154 patients (35%) reported some narcotic use 2 weeks after injury, and 15% were still using narcotics 16 weeks after injury. Narcotic use decreased over time in patients treated with open reduction and internal fixation (10% vs 15% after nonoperative management). Patients treated with open reduction and internal fixation reported reduced narcotic use at 16 weeks (odds ratio [OR], 0.454; P=.070). Concurrent rib fracture (OR, 5.668; P<.001), smoking (OR, 3.095; P=.013), unemployment (OR, 5.429; P<.0005), and long bone or spine fracture (OR, 6.761; P<.001) were predictors of narcotic use. Further studies of the social, economic, and financial outcomes of clavicle fracture and osteosynthesis are warranted. [Orthopedics. 2016; 39(5):e917-e923.].

Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

“…We did not consider subjective complications, such as functional scores or skin paresthesia, which are considered as complications of clavicle fracture repair by some authors. We further did neither assess the relationship between different implants and implant-related complications nor the use of narcotics in this study [41].…”

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

“…Seven articles did not include reports on race 9–12,14,17,19 . Seven articles did not report patient history regarding prior opioid use 9,10,14,18–21 . Another limitation is the generalized underreporting of Injury Severity Score and Abbreviated Injury Scale score within our included studies, which inhibits our analysis of opioid prescribing practices and traumatic injury that could be a result of isolated injuries versus multiple injuries.…”

“…There were also limitations regarding patient demographics because of inconsistent reporting of data between the studies. Seven articles did not include reports on race 9–12,14,17,19 . Seven articles did not report patient history regarding prior opioid use 9,10,14,18–21 .…”

“…Nine of the articles reported the mean or median of patient age to be between 30 and 55 years. [9][10][11][12][13][14][15][16]19 There were four articles in which demographics on race were able to be fully extracted 13,15,16,18 and seven articles in which racial demographics were not recorded or partially reported. [9][10][11][12]14,17,19 The articles with generalizable demographic data on race included 10,508 patients total, 7,085 patients (67.42%) were White, 969 (9.22%) were Black, and 2,454 (23.35%) were of "other" race.…”

“…After screening based on English language, title, and abstract, 433 observational studies (retrospective and prospective) and clinical trials remained. Studies that met the inclusion criteria underwent an in-depth review, resulting in 11 studies [9][10][11][12][13][14][15][16][17][18][19] (Fig. 1).…”