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Purpose Knowledge of factors associated with patient's requests for a second opioid prescription after volar plate fixation of a fracture of the distal radius might inform better pain management protocols and encourage decreased and safer use of opioids. This study tested the primary null hypothesis that there is no difference in demographics, prior opioid prescriptions, injury characteristics, and psychological factors between patients that do and do not receive a second opioid prescription following treatment volar locking plate after distal radius fracture. Patients and Methods We used data on 206 patients enrolled in one of two prospective studies. Their mean age was 53 years±SD 15, and 60 (30 %) were men. Forty-seven (23 %) patients received a second opioid prescription. We recorded additional demographics, AO fracture type, American Society for Anesthesiologists (ASA) classification, radiographic parameters at the time of injury prior to reduction and after surgery, and catastrophic thinking.Results Male sex (odds ratio [OR] 2.2, 95 % confidence interval [CI] 1.0-4.6, partial pseudo R 2 =0.018, P=0.044) and greater dorsal angulation of the articular surface on the lateral post injury radiograph (OR 0.98, 95 % CI 0.96 to 1.0, partial pseudo R 2 =0.033, P=0.040) were associated with a second opioid prescription after surgery (pseudo R 2 0.12, P=0.0071). Conclusions One measure of fracture severity (dorsal displacement) was independently associated with a second opioid prescription, but alone it accounted for 3.3 % of the variation. Other factors such as the patient's expectation prior to surgery, in particular the realization that injury and surgery hurt, might be addressed in future research. Level of Evidence Prognostic II

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The consistent finding that general patient-reported outcomes correlate moderately with regional patient-reported outcomes suggests that a small number of relatively nonspecific patient-reported outcome measures might be used to assess a variety of illnesses. In our opinion, the blending of physical and mental health questions in the PROMIS Global Health makes this instrument less useful for research or patient care.

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The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. Variation might decrease with improved diagnostic techniques and consideration of practice guidelines. Future studies are needed to determine the patients and injuries that will benefit most from surgery.

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