Crppf supracondylar fracture9/10/2023 To determine the optimal dose of opioids that should be prescribed, Shah and his colleagues launched a prospective study of patients who underwent closed reduction and percutaneous pinning (CRPP) of supracondylar humerus (SCH) fractures - the most common elbow fracture in children. “When we’re prescribing analgesic opioids for young patients, we not only want to avoid overtreating this group of patients, but we also want to make sure we’re not undertreating pain as they recover from surgery,” said Apurva Shah, MD, MBA, an orthopaedic surgeon at CHOP, Co-director of the Brachial Plexus Injury Program and lead author of this study. While younger children are less likely to abuse opioids, accidental ingestion is on the rise and can result in significant injury or death. Adolescents are also more likely to abuse substances as adults if they have used opioids for both medical and non-medical reasons. Across the country, more than half of all opioid prescriptions were given to patients discharged by orthopaedic surgeons.Īdditionally, about 40 percent of adolescents who took opioids for non-medical reasons had access to them from leftover prescriptions. Opioid diversion and non-medical use of opioids are tremendous challenges as the medical community strives to achieve improved opioid stewardship. The findings were published on January 16, 2019, in the Journal of Bone and Joint Surgery. The patients used less than 25 percent of the drugs, suggesting a potential risk of opioid diversion. No differences existed between the sexes and a higher volume of fixations occurred during the summer months.Apurva Shah, MD, MBA Opioid drugs prescribed to children for pain relief after a typical pediatric orthopaedic procedure may be significantly overprescribed, according to a new study by researchers at Children’s Hospital of Philadelphia (CHOP). Conclusions: While SCF fixation is common, the rate of re-operation is low. Increased surgeon volume of SCF fixation was protective against repeat fixation (odds ratio: 0.9 (CI: 0.9-1.0)) and re-operation in the long term (HR: 0.9 (CI: 0.8-1.0)). As compared to CRPP, patients who underwent OR were more likely to undergo early nerve exploration (odds ratio: 7.8 (CI: 3.0-20.6)) and re-operation in the long term (HR: 3.0 (CI: 1.0-8.7)). Re-operation was uncommon in the immediate (1.0%), short-term (1.4%) and long-term (0.3%) follow-up period. The overall IDR was 20.7/100,000person-years (py), but it varied significantly by season and age. The majority underwent a CRPP (78.7%) which were performed after hours (75.6%). The median follow-up was 6.0 years (IQR: 3.7). Results: A total of 3235 patients with a median age of 6.0 years (interquartile range (IQR): 3.0) underwent SCF fixation. A multivariate regression (immediate and short-term re-operation) and a Cox proportional hazards model (long-term re-operation) were used to identify patient, injury and provider factors that influenced re-operation risk and were reported as odds ratios or hazard ratios (HRs) with 95% confidence intervals (CIs), respectively. The overall IDR of SCF fixation and for subgroups of age, sex and season were calculated. Exclusion criteria included age (>12 years), a prior or concurrent non-SCF elbow fracture or previous humeral osteotomy. Methods: Using administrative databases, all patients who underwent SCF fixation (closed reduction percutaneous pinning (CRPP) or open reduction (OR)) in Ontario between April 2002 and March 2010 were identified. The purpose of this study was to: (1) determine the incidence density rate (IDR) of SCF fixation and (2) determine the rate of and risk factors for re-operation. Khoshbin, Amir | Leroux, Timothy | Wasserstein, David | Wolfstadt, Jesse | Law, Peggy W | Mahomed, Nizar | Wright, James GĪbstract: Introduction: The epidemiology of paediatric supracondylar fracture (SCF) fixation has not been evaluated at a population level. The epidemiology of paediatric supracondylar fracture fixation: A population-based study
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