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Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries.

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Patients with pilon or bicondylar tibial plateau fractures receive higher opiate prescriptions. This study analyzed morphine milligram equivalents (MMEs) for lower extremity fractures and developed a guideline for opiate prescribing.

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Area of Science:

  • Orthopaedic Surgery
  • Pain Management
  • Pharmacology

Background:

  • Opioid prescribing patterns for lower extremity fractures vary significantly.
  • Understanding these patterns is crucial for developing evidence-based guidelines.
  • Previous research has not comprehensively analyzed MMEs across different fracture types and provider specialties.

Purpose of the Study:

  • To identify opiate prescribing practices and morphine milligram equivalents (MMEs) for operatively treated isolated lower extremity fractures.
  • To compare MME prescriptions between orthopaedic and nonorthopaedic providers.
  • To develop opiate prescribing recommendations based on current practices.

Main Methods:

  • Retrospective analysis of 341 patients with isolated lower extremity fractures (2005-2016).
  • Opiate prescribing data obtained from the State Controlled Substance Monitoring Database.
  • Morphine milligram equivalents (MMEs) calculated and converted to oxycodone 10 mg (OC 10 mg) pills for clinical relevance.

Main Results:

  • Patients with pilon or bicondylar tibial plateau fractures received significantly higher MMEs compared to unicondylar and ankle fractures.
  • Both orthopaedic and nonorthopaedic providers prescribed more opiates for pilon fractures.
  • Significant differences in MMEs prescribed were observed between orthopaedic and nonorthopaedic providers for all injury types.

Conclusions:

  • Pilon and bicondylar tibial plateau fractures are associated with higher opiate prescriptions.
  • An opiate prescription guideline has been developed based on orthopaedic provider practices.
  • This guideline aims to standardize and optimize opiate prescribing for lower extremity fractures.