Opioid use in impending versus pathologic proximal femur fractures

To investigate post-operative opioid use, functionality, and overall survival following internal fixation for pathologic or impending fractures at 3 and 6 months.

Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for post-operative pain relief. This study compared post-operative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur.

This was a retrospective case-control study of patients using opioids post-operatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and post-operative opioid usage as well as ambulation status and risk factors at 3 and 6 months associated with post-operative opioid use were recorded.

Twenty-four pathologic fractures and 23 impending fractures were included. Preoperative opioid daily morphine milligram equivalent was significantly higher in the pathologic fracture group, but there were no significant differences at 3 or 6 months. There was statistically significant post-operative improvement in ambulation status in the combined cohort and impending fracture cohort at 3 months and 6 months.

Although patients did not experience a significant post-operative change in opioid use, patients with pathologic fractures notably required higher opioid dosages preoperatively, and there was overall improvement in function following fixation. Future studies should examine post-operative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.