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Association of Cannabis Use with Metacarpal and Phalanx Fracture Complications
Joseph Amadeo Lewcun, MD
1, Naomi Ghahrai, BS
2, Stephanie Shin, MD
1, Megan R Newsom, MD
1, Brooks J Knighton, MD
1, Rendell Bernabe, MD
1, Carly O'Donnell, MD
1, Alexandra Vagonis, MD
3; Paschalia Mountziaris, MD, PhD
1(1)Virginia Commonwealth University, Richmond, VA, (2)Virginia Commonwealth University School of Medicine, Richmond, VA, (3)Virginia Commonwealth University, Ricmond, VA
Introduction: While cannabis legalization has become more common across the United States, little is known about its effects on outcomes in the hand trauma population. The aim of this study was to examine of the association of frequent cannabis use with complications in patients with metacarpal and phalanx fractures.
Materials and Methods: A retrospective review of all isolated metacarpal and phalanx fractures at a single academic medical center from 2019-2023 was conducted. Outcome measures such as surgical site infection, malunion/nonunion, reduced range of motion, and reoperation were compared between patients with frequent cannabis use (>4 times per week) and those without.
Results: 391 patients with isolated metacarpal and/or phalanx fractures were included. 9.97% (n=39) reported frequent cannabis use while 90.03% (n=352) did not. Patients in the cannabis use group had increased rates of surgical site infection (10.26% vs 0.85%, p=0.002), nonunion/malunion (15.38% vs 3.13%, p=0.004), reduced range of motion (15.38% vs 6.25%, p=0.036) and reoperation (12.82% vs 3.41%, p=0.019). On multivariate analysis, frequent cannabis use was a significant predictor of surgical site infection and nonunion/malunion. Of note, the association with nonunion/malunion and surgical site infection appeared to be independent of nicotine use in this cohort.
Conclusions: Frequent cannabis use is associated with increased rates of malunion/nonunion, surgical site infection, and need for reoperation. While further study is necessary to determine whether this increased risk can be attributed to cannabis itself, hand surgeons should be aware of the association with increased rates of complications in this population.
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