What Orthopaedic Surgeons Need to Know: The Basic Science Behind Opioids.

On October 26, 2017, US president, Donald J. Trump, declared the opioid epidemic a national public health emergency. This declaration opened the door to government funding for programs geared toward studying and treating opioid addiction; however, part of the responsibility to slow the epidemic falls on physicians. Orthopaedic surgeons prescribed the third-highest number of narcotic prescriptions among all physician groups, and therefore, they have a major role to play in decreasing the use of opioids. Although restricting prescriptions is part of the solution, orthopaedic surgeries are often painful, and opioid medications, along with other multimodal nonopioid medications, allow patients to control pain and improve function, especially in the short term. Therefore, to successfully manage pain and opioid prescriptions, orthopaedic surgeons should know the basic science behind these powerful medications. Understanding the basic mechanism of action of opioid and nonopioid medication classes, knowing what oral morphine equivalent are, and knowing which nonopioid drugs can amplify or weaken the potency of opioids will help orthopaedic surgeons become more informed prescribers and leaders in helping control the opioid epidemic.

Carpal Coalitions and Metacarpal Synostoses: A Review.

Background: Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. Methods: A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. Results: The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Conclusions: Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.