Orthopedic trauma in patients with opioid use disorder: Current concepts in perioperative management

Opioid use disorder (OUD) is an important challenge in orthopedic trauma, where acute injury intersects with preexisting opioid exposure, tolerance, complex pain, and barriers to continuity of addiction treatment. OUD has been associated with higher rates of complications, readmission, and treatment disruption, yet OUD-specific perioperative management remains inconsistently incorporated into orthopedic trauma practice. This review synthesizes the epidemiology, outcomes, and perioperative management evidence for this population.

A clinically oriented current concepts review synthesized peer-reviewed literature, prioritizing studies published from 2013 onward. PubMed and Embase were searched, supplemented by Google Scholar, Semantic Scholar, and manual review of reference lists from relevant articles. Studies examining perioperative outcomes, multimodal analgesia, and management of medications for OUD (MOUD) relevant to orthopedic trauma were included; studies limited to pediatric, elderly, or prenatal populations were excluded.

Preinjury opioid exposure is common among orthopedic trauma patients, whereas formally diagnosed OUD is less prevalent, affecting approximately 1% of operative trauma patients and up to 2.3% of patients with open lower-extremity fractures. OUD and opioid-related disorders are associated with higher rates of infection, nonunion, revision, prolonged hospitalization, and readmission. Consensus guidance and observational evidence support continuation of evidence-based MOUD, individualized opioid supplementation, multimodal nonopioid analgesia, regional anesthesia when appropriate, and early coordination with addiction and acute pain services. Guideline-based approaches to postoperative opioid prescribing, tapering, and patient education are also summarized.

Orthopedic trauma patients with OUD require individualized, multidisciplinary perioperative care. The strongest available evidence supports preservation of OUD treatment, multimodal analgesia, early addiction and pain consultation, and coordinated discharge planning rather than either opioid avoidance or opioid-only treatment. The review concludes with the authors' recommendations for the operating surgeon, including in-hospital and outpatient tapering plans, management of requests for additional opioids, and patient education.