Are Surgically Treated Long Bone Fractures in Adolescents Linked to Higher Rates of Substance Use Disorder? A...

Adolescents recovering from operatively treated traumatic fractures face significant perioperative challenges, including pain, functional limitations, and psychological distress. Pain management often involves the use of opioids, which may contribute to the subsequent risk of developing substance use disorders (SUDs). This study explores the relationship between surgically treated upper and lower-extremity long-bone fractures and the subsequent risk of developing SUDs.

This retrospective, propensity-matched cohort study used the TriNetX US Collaborative database, which encompasses over 115 million patient records. Adolescents aged 14 to 17 years or younger with surgically treated upper (n=24,249) or lower (n=16,507) extremity fractures were compared with matched controls without fractures (n=24,249 and 16,507, respectively). Patients with prior psychiatric, substance use, or insomnia disorders were excluded. Hazard ratios (HRs) for SUD diagnoses were estimated over a 2-year follow-up period using a Cox proportional hazards model.

Adolescents with surgically treated upper extremity fractures have a moderate but significant increase in SUD risk (HR=1.3) compared with matched controls. In addition, those with surgically treated lower-extremity fractures have a significantly increased risk (HR=1.7) of developing substance use disorders compared with matched controls.

Adolescents with surgically treated long-bone fractures are at increased risk of developing SUDs, particularly following lower-extremity fractures. These findings highlight opportunities for opioid-sparing pain management and early identification of at-risk adolescents, which may warrant further investigation as strategies to mitigate this risk.

Level III-retrospective cohort study.