Opioid use in impending versus pathologic proximal femur fractures

Austin Yu; Conor M. Jones; Gayathri Vijayakumar; Amr Turkmani; Zachary Butler; Andre Cargill; Matthew W. Colman; Steven Gitelis; Alan T. Blank

doi:10.5055/jom.0884

Authors

Austin Yu, BS https://orcid.org/0000-0003-0076-277X
Conor M. Jones, MD
Gayathri Vijayakumar, BS https://orcid.org/0000-0001-7324-4864
Amr Turkmani, BS
Zachary Butler, BS
Andre Cargill, MS
Matthew W. Colman, MD
Steven Gitelis, MD https://orcid.org/0000-0001-7413-2549
Alan T. Blank, MD, MS https://orcid.org/0000-0003-2531-5976

DOI:

https://doi.org/10.5055/jom.0884

Keywords:

pathologic fracture, metastatic bone disease, oncology, opioid

Abstract

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

Background: 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.

Design: This was a retrospective case–control study of patients using opioids postoperatively 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 postoperative opioid use were recorded.

Results: 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.

Conclusions: 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.

Author Biographies

Austin Yu, BS

Medical Student, Research Fellow, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Conor M. Jones, MD

Resident Physician, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Gayathri Vijayakumar, BS

Medical Student, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Amr Turkmani, BS

Medical Student, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Zachary Butler, BS

Medical Student, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Andre Cargill, MS

Medical Student, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Matthew W. Colman, MD

Associate Professor, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Steven Gitelis, MD

Professor, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

Alan T. Blank, MD, MS

Associate Professor, Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois

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