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ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

Is a positive urinary toxicology screen in femoral shaft fractures associated with longer hospital length of stay and increased opioid use?

Mustafa Alkhouli, Eric Huish, William Holmes, Brendan Liakos, Richard Gellman

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

5 authors.

Mustafa AlkhouliValley Consortium for Medical Education, Modesto, Ca, United States.
Eric HuishSan Joaquin General Hospital, French Camp, United States.
William HolmesSan Joaquin General Hospital, French Camp, United States.
Brendan LiakosValley Consortium for Medical Education, Modesto, Ca, United States. BrendanJLiakos@gmail.com.
Richard GellmanSan Joaquin General Hospital, French Camp, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS).

methodsDesign: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16 years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen.

resultsA total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273).

conclusionsTrauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

Indexed as

Analgesics, OpioidFemoral FracturesFracture Fixation, IntramedullaryLength of StayAdultAgedFemaleHumansMaleMiddle AgedMorphineRetrospective StudiesSubstance Abuse DetectionYoung AdultAnalgesics, OpioidMorphineFemoral fracturesIntramedullary nailingSubstance abuseUrine specimen collection

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