Opioid Prescribing Practices After Isolated Pilon Fractures.

Area of Science:

• Orthopedics
• Pain Management
• Pharmacology

Background:

• Pilon fractures are severe lower-extremity injuries requiring operative treatment.
• Opioid prescribing patterns after surgery are not well-defined, especially concerning prior opioid exposure.
• Understanding these patterns is crucial for managing pain and preventing long-term opioid use.

Purpose of the Study:

• To investigate opioid prescribing practices following operative treatment of isolated pilon fractures.
• To quantify opioid dosage and identify prescribers.
• To compare prescribing patterns between opioid-exposed and opioid-naive patients.

Main Methods:

• Retrospective review of 72 patients with operatively treated isolated pilon fractures (2005-2015) at a Level 1 trauma center.
• Calculation of total morphine milligram equivalents (MMEs) prescribed.
• Utilized State Controlled Substance Monitoring Database to assess prior opioid exposure.

Main Results:

• Median MMEs prescribed was 2738; orthopedic providers accounted for 61% of MMEs.
• 54% of patients had prior opioid exposure; these patients received significantly more MMEs.
• 38.9% of patients continued opioid use >6 months post-injury; 25% of these were opioid-naive initially.
• 39% of prescriptions originated from non-orthopedic providers.

Conclusions:

• Significant variability exists in opioid prescribing for pilon fractures.
• Prior opioid exposure is associated with higher MME prescriptions and longer duration of use.
• A standardized prescribing approach, such as 40 pills of oxycodone 10 mg with limited refills, may be appropriate for adequate pain control.