Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):3881-3887. doi: 10.1007/s00590-024-04058-7. Epub 2024 Sep 13.
The operative treatment of mid-shaft clavicle fractures shows benefit in union rates, return to work, and lower pain scores relative to non-operative treatment. We sought to determine if the surgical treatment of isolated mid-shaft clavicle fractures would result in fewer opioids prescribed as compared to those managed non-operatively.
All mid-shaft clavicle fractures treated at a Level 1 trauma center were identified from 2012 to 2016. Demographics, fracture characteristics, surgical complications/outcomes, non-operative outcomes, and all narcotics prescribed for 6 months post-injury were collected. Narcotic prescriptions, in morphine equivalents (ME), were obtained through the state prescription drug monitoring program (PDMP).
One hundred and ten operative and 48 non-operative patients were included. Age, gender, previous alcohol, tobacco or drug use, and final range of motion were similar between groups. Pre-treatment fracture shortening (1.8 cm vs. 0.7 cm, p < 0.001) and displacement (150% vs. 70%, p < 0.001) were greater in the operative group. Total ME's (604 vs. 187, p < 0.001) and post-operative ME's (420 vs. 187, p < 0.001) were greater for the operative group. In either group, no other variable influenced ME's prescribed.
Clavicles treated operatively receive substantially more opiates than those treated non-operatively, despite data suggesting that operative treatment makes clavicle fractures less painful. The total amount of narcotic analgesics obtained by operatively treated patients was over three times that obtained by non-operatively managed patients, which equates to 55 5 mg oxycodone pills or 85 5 mg hydrocodone pills per patient. While there may certainly be advantages to the operative treatment of clavicle fractures, they must be weighed against the risks of a significant increase in opiate prescribing and potential consumption.
与非手术治疗相比，手术治疗锁骨中段骨折在愈合率、重返工作岗位和降低疼痛评分方面更具优势。我们试图确定与非手术治疗相比，手术治疗单纯锁骨中段骨折是否会导致开处的阿片类药物更少。
从 2012 年至 2016 年，在一家 1 级创伤中心确定了所有锁骨中段骨折患者。收集了人口统计学、骨折特征、手术并发症/结果、非手术结果以及受伤后 6 个月内开具的所有麻醉性镇痛药。通过州处方药物监测计划（PDMP）获得麻醉性镇痛药的处方量（以吗啡当量计）。
纳入 110 例手术和 48 例非手术患者。两组患者的年龄、性别、既往酒精、烟草或药物使用情况以及最终活动范围相似。术前骨折缩短（1.8cm 对 0.7cm，p<0.001）和移位（150%对 70%，p<0.001）在手术组更大。手术组的总吗啡当量（604 对 187，p<0.001）和术后吗啡当量（420 对 187，p<0.001）均更大。在任何一组中，其他变量都不会影响开处的吗啡当量。
与非手术治疗的锁骨骨折相比，手术治疗的锁骨骨折接受了大量的阿片类药物，尽管数据表明手术治疗使锁骨骨折的疼痛减轻。手术治疗患者获得的阿片类镇痛药物总量是接受非手术治疗患者的三倍多，相当于每位患者 55 片 5mg 羟考酮片或 85 片 5mg 氢可酮片。虽然手术治疗锁骨骨折可能有一定的优势，但必须权衡手术治疗带来的阿片类药物处方显著增加和潜在消耗的风险。
