The Highs and Lows of Fracture Fixation: Complications After Wrist Fracture Fixation for Users of Cannabis, Tobacco, or Neither Substance.

Abstract

We investigated associations of cannabis and tobacco use with complications after open reduction and internal fixation (ORIF) of wrist fractures. We retrospectively analyzed PearlDiver data from 337 538 patients who underwent ORIF for wrist fractures from 2010 to 2022. We identified 5587 patients with a history of cannabis use disorder ("cannabis group"); 12 806 patients with a history of tobacco use and no history of cannabis use disorder ("tobacco group"), and 310 108 patients with no history of cannabis use disorder or tobacco use ("control group"). We excluded patients with a history of using other illicit drugs. Propensity matching was used to control for age, sex, and comorbidity burden. Demographic characteristics, comorbidity profiles, and medical and surgical complications were compared using chi-squared tests. Complications were assessed within 90 days after surgery. Postoperative outcomes were also stratified by fracture location. Alpha = .05. Compared with the control group, the cannabis group had a significantly higher incidence of all medical complications and of fracture malunion, nerve injury, and tendon, muscle, or fascia injury. Compared with the tobacco group, the cannabis group had significantly lower incidence of sepsis, pneumonia, deep venous thrombosis, urinary tract infection, nerve injury, and wound dehiscence. Compared with nonusers of cannabis and tobacco, cannabis users had a higher incidence of several medical and surgical complications after ORIF for wrist fractures. These findings will help physicians better anticipate complications in patients who use cannabis or tobacco.