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Impact of Preoperative Opioids on Outcomes After Phalanx Fracture Open Reduction and Internal Fixation
Joshua Wang, MS
1, Philong Nguyen, BS
1, Manav M Patel, BSA
1, Yousef Tanas, MD
2; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX
Introduction: Preoperative opioid use has been linked to poorer outcomes across various orthopedic procedures, yet its impact on hand-specific surgeries remains underexplored. This study evaluates the association between preoperative opioid use and postoperative complications following open reduction and internal fixation (ORIF) of phalanx fractures.
Methods: Using the TriNetX Research database, adults (?18 years) who underwent phalanx ORIF between 2017 and 2023 were identified and stratified based on documented preoperative opioid use. Propensity score matching was performed in a 1:1 ratio, adjusting for age, sex, BMI, smoking status, diabetes, cardiovascular disease, osteoarthritis, rheumatoid arthritis, and other comorbidities. Primary outcomes included revision surgery, repair of malunion or nonunion, hardware removal, infection, wound complications, thromboembolic events, postoperative pain syndromes, and CRPS. Risk ratios and 95% confidence intervals were assessed at 90 days and 2 years per outcome, with statistical significance set at p < 0.05.
Results: At 90 days, patients with prior opioid use had significantly higher rates of revision surgery (RR: 5.00; p < 0.0001) and complex regional pain syndrome or persistent hand/finger pain (RR: 1.19; p < 0.0001). No significant differences were found in rates of wound disruption, infection, sepsis, or thromboembolic events. At 2 years, opioid users had markedly increased risks of revision (RR: 6.16; p < 0.0001) and repair of malunion or nonunion (RR: 1.53; p = 0.017). Hardware removal was not significantly different.
Conclusion: Preoperative opioid use is associated with significantly increased risks of revision surgery and persistent postoperative pain following phalanx ORIF. These patients also face higher odds of requiring repair for malunion or nonunion at long-term follow-up. However, no significant differences were observed in rates of infection, wound complications, or thromboembolic events. These findings highlight the need for careful preoperative assessment and optimization of opioid use to improve surgical outcomes in hand fracture management.
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