Marijuana Use Results in Increased Time to Union in Surgically Treated Pediatric Fracture Patients

Objective: To identify the impact of marijuana use on fracture healing in surgically treated pediatric patients. Design: Retrospective review. Setting: Level 1 trauma center, single-center study. Patients/Participants: Surgically treated pediatric patients 10–18 years with extremity fractures from 2010 to 2020. Conservatively treated patients and patients with nonunions were excluded from the study. Three hundred thirty-nine patients were included in the study, 21 of which were confirmed marijuana users by toxicology screening. Intervention: Surgical treatment of extremity fractures by any type of fixation. Main Outcome Measurements: Time to union was the primary outcome and was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line. Analysis of covariance, logistic regression analysis, and Fisher exact tests were used to establish the relationship between all collected variables and time to radiographic union. Results: The average time to union for marijuana users (159.1 ± 69.5 days, 95% confidence interval) was significantly longer than for nonusers (80.3 ± 7.8 days), P < 0.001. The odds of having a time to union of greater than 4 months and greater than 6 months were 4.17 (P = 0.00192) and 6.19 (P = 0.000159), respectively, for marijuana users compared with nonusers. Conclusion: Marijuana users demonstrated longer time to union in surgically treated pediatric fracture patients. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.