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Impact of Cannabis and Nicotine Use on Short-Term Outcomes Following Distal Radius Fracture Fixation
Iyad S Ali, MD
1, Angad S. Sidhu, BS
2, Avani A. Chopra, MD
3; Khusboo Desai, MD
1(1)Indiana University School of Medicine, Indianapolis, IN, (2)Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, (3)Penn State College of Medicine, Hershey, PA
Introduction:Cannabis and nicotine use are increasingly relevant risk factors in orthopaedic outcomes but remain understudied in fracture healing. This study evaluated the impact of cannabis use and nicotine dependence on short-term outcomes following open treatment of distal radial fractures (DRF), focusing on complications and healthcare utilization within 30 and 90 days postoperatively.
Materials & Methods:The TriNetX database, a large deidentified electronic health record program, was analyzed (2005-2025) for patients who underwent DRF open reduction and internal fixation (CPT: 25607, 25608, 25609). Patients were divided into three groups: cannabis use, nicotine dependence, or neither (control). The patients were then propensity matched by age, sex, and body mass index (BMI), and complication rates (nonunion, wound complication, and return to operating room) were assessed at 30- and 90-days postoperatively. P-values ?0.05 were considered statistically significant.
Results:In the 30-day comparison, cannabis users had a significantly higher risk of minor adverse events (10.5%) than nicotine users (4.9%), yielding a risk ratio of 2.16 (p=0.003). Compared to controls, nicotine users showed increased risk of wound dehiscence (0.7% vs. 0.5%, p=0.027) and surgical site infection at 90 days (1.0% vs. 0.6%, p=0.006). Cannabis use did not significantly differ from controls for individual wound complications but showed a trend toward higher overall adverse event rates. Comparisons between cannabis and nicotine users at 90 days showed similar rates for most outcomes except a higher incidence of wound dehiscence in cannabis users (2.6% vs. 0%, p=0.001).
Conclusions:Cannabis and nicotine use were each associated with increased short-term risks following DRF surgery, with cannabis users showing nearly double the rate of minor adverse events compared to nicotine users at 30 days and a higher risk of wound complications at 90 days. Nicotine use was linked to higher wound infection and dehiscence rates than controls. These findings highlight the need for preoperative counseling and tailored perioperative management in patients who use cannabis or nicotine. Prospective studies should further clarify causality and guide risk-reduction strategies.
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