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Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0–24 h (h) and 24–36 h postoperative period.

Methods

A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0–24 h and 24–36 h postoperatively.

Results

330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0–24 h (25.4% estimated mean increase, p value = 0.02) and 24–36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age.

Conclusion

Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures.

Level of evidence

Therapeutic level III.

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Funding

 The authors did not receive funding or support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA

    Richard W. Pectol, Matthew W. Kavolus, Axel Kiefer, Chandler R. Sneed, Tanner Womble, Jeffrey A. Foster, Daria L. Kinchelow, Paul E. Matuszewski, David C. Landy & Arun Aneja

  2. Department of Statistics, University of Kentucky, Lexington, KY, USA

    Gregory S. Hawk

Authors
  1. Richard W. Pectol
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Contributions

AA, DCL, and PEM conceived the presented idea and research design. RWP, AK, MWK, and TW contributed towards the acquisition of data. AA, DCL, and GSH performed the analysis and interpretation of data. RWP, MWK, CRS, JAF, and DLK wrote and revised the manuscript in consultation with the previously listed authors. All authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to Jeffrey A. Foster.

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Conflict of interest

Financial Interests: Daria L. Kinchelow or an immediate family member owns stock or stock options in Procter & Gamble. Paul E. Matuszewski is a paid consultant for and has received research support from BONESUPPORT, Smith & Nephew, and Stryker. Arun Aneja is a paid consultant for Depuy Synthes and Runatek and has received research or institutional support from Department of Defense, Orthopaedic Trauma Association, and AO Trauma North America. Arun Aneja or an immediate family member is a member of a speaker’s bureau or has made paid presentations on behalf of Depuy Synthes and AO Trauma North America. All remaining authors declare they have no financial interests.

Non-financial interests: David C. Landy is an editorial or governing board member for the American Journal of Sports Medicine and is an associate editor for Clinical Orthopaedics and Related Research. Paul E. Matuszewski is a board of committee member for American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association. Arun Aneja is a board or committee member for American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association. All remaining authors declare they have no non-financial interests.

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Pectol, R.W., Kavolus, M.W., Kiefer, A. et al. Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures. Eur J Orthop Surg Traumatol 33, 3135–3141 (2023). https://doi.org/10.1007/s00590-023-03553-7

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