Ramtin Sina, Khan Sara, Chhabra Vijay, Pirzada Wali, Khak Mohammad, Ilyas Asif M
Rothman Institute Foundation for Opioid Research & Education, Philadelphia, Pennsylvania, USA.
Orthopedic Surgery Department, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
J Hand Surg Glob Online. 2025 May 31;7(4):100759. doi: 10.1016/j.jhsg.2025.100759. eCollection 2025 Jul.
While most opioid research focuses on postoperative use, limited data exist on prescribing patterns in nonsurgical management of common injuries such as distal radius fractures (DRFs). This study aimed to assess opioid prescribing trends and identify factors linked to prolonged use in nonsurgically treated DRFs.
A retrospective cohort study of 591 patients aged 18-50 with nonsurgically managed DRFs between 2018 and 2024 was conducted. Opioid use was classified as prior opioid use (POU), fracture-related opioid use (FxOU), or delayed opioid use (DOU). Prescription data were obtained from the Prescription Drug Monitoring Program and analyzed for morphine milligram equivalents, number of prescriptions, prescriber type, and timing relative to orthopedic consultation.
Only 32% of patients received an opioid prescription after their DRF. Among the 189 who did, 35% were POU; 37% were FxOU, and 28% were DOU. Orthopedic surgeons prescribed opioids in just 6% of total cases and 19% of cases among opioid recipients; 81% of prescriptions came from nonorthopedic providers. Surgeons wrote only 11% of FxOU prescriptions, whereas 56% of POU and DOU prescriptions were from nonorthopedic prescribers. Patients with POU had significantly higher cumulative morphine milligram equivalents compared with those with FxOU. No significant morphine milligram equivalent or prescription count difference was found between surgeons and nonorthopedic prescribers, but patients with DOU had a higher prescription count.
Most patients with nonsurgical DRFs did not receive opioids. When prescribed, over 80% of opioids originated from nonorthopedic providers. Delayed opioid use and POU were associated with increased cumulative exposure, highlighting the need for fracture surgeons to take a more active role in opioid stewardship and for improved coordination across providers to reduce unnecessary opioid exposure.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
虽然大多数阿片类药物研究集中在术后使用，但关于常见损伤（如桡骨远端骨折[DRF]）非手术治疗中的处方模式的数据有限。本研究旨在评估阿片类药物的处方趋势，并确定与非手术治疗DRF中使用时间延长相关的因素。
对2018年至2024年间591例年龄在18至50岁、接受非手术治疗DRF的患者进行了一项回顾性队列研究。阿片类药物的使用分为既往阿片类药物使用（POU）、骨折相关阿片类药物使用（FxOU）或延迟阿片类药物使用（DOU）。处方数据从处方药监测计划中获取，并分析吗啡毫克当量、处方数量、开处方者类型以及相对于骨科会诊的时间。
只有32%的患者在DRF后接受了阿片类药物处方。在接受处方的189例患者中，35%为POU；37%为FxOU，28%为DOU。骨科医生仅在所有病例的6%以及阿片类药物接受者中的19%病例中开具阿片类药物；81%的处方来自非骨科医生。外科医生仅开具了11%的FxOU处方，而56%的POU和DOU处方来自非骨科开处方者。与FxOU患者相比，POU患者的累积吗啡毫克当量显著更高。在外科医生和非骨科开处方者之间未发现显著的吗啡毫克当量或处方数量差异，但DOU患者的处方数量更高。
大多数非手术治疗DRF的患者未接受阿片类药物。开具处方时，超过80%的阿片类药物来自非骨科医生。延迟阿片类药物使用和POU与累积暴露增加相关，这突出表明骨折外科医生需要在阿片类药物管理中发挥更积极的作用，并改善各医疗服务提供者之间的协调，以减少不必要的阿片类药物暴露。
研究类型/证据水平：预后性II级。
