Factors Associated With Narcotic Use After Clavicle Fractures

• Published in: Orthopedics (Thorofare, N.J.) Vol. 39; no. 5; pp. e917 - e923
• Main Authors: Weinberg, Douglas S, Napora, Joshua K, West, William H, Grimberg, Dominic C, Vallier, Heather A
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.09.2016
• Subjects: Adult; Alcohol use; Analgesics, Opioid - administration & dosage; Awards & honors; Chi-square test; Clavicle - injuries; Employment; Female; Fracture Fixation, Internal - statistics & numerical data; Fractures, Bone - therapy; Fractures, Open - therapy; Functional Laterality; Humans; Injuries; Male; Middle Aged; Narcotics; Open Fracture Reduction - statistics & numerical data; Open fractures; Orthopedics; Patients; Regression Analysis; Response rates; Social history; Spinal Fractures; Surgery; Trauma; Treatment Outcome; Trends
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20160623-06

Clavicle fractures are common in adults. Recent studies have shown that operative treatment of clavicle fractures has benefits in many situations. However, there is controversy about the indications. Data on social outcomes are limited. A total of 434 patients with 436 clavicle fractures treated both operatively and nonoperatively at a level 1 trauma center were identified. Narcotic use was recorded 2, 4, 6, 8, 10, 12, 14, and 16 weeks after injury for both treatment groups. Other descriptive data included age, sex, laterality, hand dominance, rib fractures, smoking, alcohol use, employment, long bone or spine fracture, open clavicle fracture, and mechanism of injury. Logistic regression analysis was performed to determine the independent predictors of narcotic use after clavicle fracture. Open reduction and internal fixation was performed in 105 fractures (24%), and 329 fractures were managed nonoperatively. A total of 154 patients (35%) reported some narcotic use 2 weeks after injury, and 15% were still using narcotics 16 weeks after injury. Narcotic use decreased over time in patients treated with open reduction and internal fixation (10% vs 15% after nonoperative management). Patients treated with open reduction and internal fixation reported reduced narcotic use at 16 weeks (odds ratio [OR], 0.454; P=.070). Concurrent rib fracture (OR, 5.668; P<.001), smoking (OR, 3.095; P=.013), unemployment (OR, 5.429; P<.0005), and long bone or spine fracture (OR, 6.761; P<.001) were predictors of narcotic use. Further studies of the social, economic, and financial outcomes of clavicle fracture and osteosynthesis are warranted. [Orthopedics. 2016; 39(5):e917-e923.].