Opioid Prescription Following Wrist and Ankle Fracture Fixation in Scotland—Tradition Prevails

William T. Gardner* (Corresponding Author), David R.W. Macdonald, Matthew J. Kennedy, Alastair C. Faulkner, Joshua R. McIntyre, Patrice Forget, Stuart A. Aitken, Iain M. Stevenson, Scottish Orthopaedic Research collaborative (SCORE)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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The American ‘opioid crisis’ is rapidly spreading internationally. Perioperative opioid use increases the risk of long-term opioid use. We review opioid use following wrist and ankle fracture fixation across Scotland, establishing prescribing patterns and associations with patient, injury, or perioperative factors. Six Scottish orthopedic units contributed. A total of 598 patients were included. Patient demographics were similar across all sites. There was variation in anesthetic practice, length of stay, and AO fracture type (p < 0.01). For wrist fractures, 85.6% of patients received a discharge opioid prescription; 5.0% contained a strong opioid. There was no significant variation across the six units in prescribing practice. For ankle fractures, 82.7% of patients received a discharge opioid prescription; 17% contained a strong opioid. Dundee and Edinburgh used more strong opioids; Inverness and Paisley gave the least opioids overall (p < 0.01). Younger patient age, location, and length of stay were independent predictors of increased prescription on binary regression. Despite variability in perioperative practices, discharge opioid analgesic prescription remains overwhelmingly consistent. We believe that the biggest influence lies with the prescriber-institutional ‘standard practice’. Education of these prescribing clinicians regarding the risk profile of opioids is key to reducing their use following surgery, thus lowering long-term opioid dependence.

Original languageEnglish
Article number468
Number of pages10
JournalJournal of Clinical Medicine
Issue number2
Early online date17 Jan 2022
Publication statusPublished - 17 Jan 2022

Data Availability Statement

Supplementary Materials: The following are available online at https://www.mdpi.com/article/10.3390/jcm11020468/s1, Membership of the Score Collaborators

Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the details of the injuries being potentially patient identifiable.


  • Analgesia
  • Ankle
  • Opioid
  • Trauma
  • Wrist


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