European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Correction: Parasymphyseal fracture location in lateral compression pelvic ring injuries: an assessment of reoperation and radiographic displacement in an international multicenter study.","authors":"Wayne Hoskins, Charles Gusho, Rown Parola, Daniel Bravin, Brett Crist, Alyssa Wenzel, Jaime Bellamy, Kyle Schweser, Gregory Della Rocca, Josh Milby, James Stannard, Douglas Haase","doi":"10.1007/s00590-026-04964-y","DOIUrl":"10.1007/s00590-026-04964-y","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased screw backout with non-inlay design retrograde femoral nails.","authors":"Benyamin Dadpey, Kevin Zhu, Noah Sward, Allen Dao, William Kent","doi":"10.1007/s00590-026-04983-9","DOIUrl":"10.1007/s00590-026-04983-9","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the rate of distal interlocking screw backout between inlay-design and non-inlay design retrograde intramedullary femoral nails in the treatment of distal femur fractures.</p><p><strong>Methods: </strong>Adults with AO/OTA 33 distal femur fractures treated with a retrograde ultra-high molecular weight polyethylene (UHMWPE) inlay-design nail (RFNA; DePuy Synthes) or a non-inlay design nail (T2 SCN; Stryker) between January 2015 and June 2025 at a single Level I academic trauma center with a minimum follow-up of 3 months were retrospectively reviewed. The primary outcome was distal interlocking screw backout. Secondary outcomes included time to backout diagnosis, backout distance, and rate of symptomatic screw removal. All outcomes were compared between the inlay-design and the non-inlay design cohorts.</p><p><strong>Results: </strong>A total of 134 patients were included: 76 in the inlay cohort and 58 in the non-inlay cohort. The inlay cohort demonstrated a significantly lower rate of distal interlocking screw backout compared to the non-inlay cohort (5.3% vs. 19.0%; RR 0.28, 95% CI 0.09-0.83; p = 0.02), corresponding to a 72.2% relative risk reduction. Time to backout diagnosis and backout distance did not differ significantly between designs. The rate of symptomatic screw removal was significantly lower in the inlay cohort (1.3% vs. 10.3%; p = 0.04). The distal transverse screw was the most common screw with backout in both cohorts.</p><p><strong>Conclusion: </strong>The ultra-high molecular weight polyethylene (UHMWPE) inlay at the distal interlocking interface of a retrograde femoral nail was associated with significantly lower rates of distal interlocking screw backout and symptomatic screw removal. When backout did occur, polyethylene inlay did not impact time to diagnosis and backout distance.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buried K-wires in paediatric fracture fixation: infection and complication rates in a large cohort.","authors":"Alexa Zimmermann, Johanna Thiele, Christian Prangenberg, Jonas Roos, Davide Cucchi, Sebastian Scheidt, Kristian Welle, Lisa Fiona Roder","doi":"10.1007/s00590-026-04982-w","DOIUrl":"10.1007/s00590-026-04982-w","url":null,"abstract":"<p><strong>Purpose: </strong>Kirschner wires (K-wires) are widely used for fracture fixation in paediatric trauma surgery. Although infectious complications are uncommon, they remain clinically relevant. Subcutaneous burial of K-wires has been proposed to reduce the risk of infection, but robust data from large paediatric cohorts remain limited. This study aimed to evaluate infectious and non-infectious complications following routine use of buried K-wires in children.</p><p><strong>Methods: </strong>In this retrospective cohort study, paediatric patients (≤ 18 years) who underwent fracture fixation with routinely buried K-wires at a Level I trauma centre between January 2005 and November 2025 were included. Only patients with complete follow-up, including radiographic assessment and wire removal at the study institution, were analysed. The primary outcome was postoperative infection related to K-wire fixation. Secondary outcomes included non-infectious wound complications, reoperations, and fracture healing.</p><p><strong>Results: </strong>A total of 634 patients with a mean age of 10.2 ± 4.2 years were included; 96.8% sustained upper-extremity fractures. One superficial infection occurred (0.16%; 95% CI 0.00-0.88%), with no cases of deep infection or osteomyelitis. Secondary skin perforation without infection was observed in 8.36%, and minor wound-healing disturbances in 0.32%. No infection-related reoperations were required, and all fractures healed radiographically.</p><p><strong>Conclusions: </strong>Routine subcutaneous burial of K-wires in paediatric fracture fixation was associated with an exceptionally low rate of infectious complications and no cases of osteomyelitis in this large retrospective cohort. However, secondary skin perforation occurred in 8.36% of patients, and planned wire removal under anaesthesia represents an additional procedural burden. Given the predominance of upper-extremity fractures and the absence of an exposed-wire control group, these findings should be interpreted within the studied population and do not establish superiority over exposed K-wires.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-defined sarcopenia as a predictor of early mortality following hip fracture: a retrospective cohort study.","authors":"Vanya Sachdeva, Beatrice Walcot, Jessica Nightingale, Alan Norrish","doi":"10.1007/s00590-026-04981-x","DOIUrl":"https://doi.org/10.1007/s00590-026-04981-x","url":null,"abstract":"<p><strong>Purpose: </strong>Sarcopenia is increasingly recognised as a marker of physiological vulnerability. Computed tomography permits objective quantification of skeletal muscle mass, yet the prognostic significance of CT-defined sarcopenia after hip fracture remains incompletely characterised. This study aimed to determine sarcopenia prevalence in patients with hip fractures and evaluate associations with early postoperative outcomes.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study included patients with hip fracture during 2015 to 2025 who had abdominal computed tomography imaging, including the third lumbar vertebra (L3), within one year before fracture. Skeletal muscle area at L3 was quantified by manual segmentation on the Picture Archiving and Communication System (PACS) according to a predefined protocol. The cohort comprised 486 patients: 250 sarcopenic and 236 non-sarcopenic. Thirty-day and ninety-day mortality were the primary outcomes, analysed using adjusted logistic regression and 90-day time-to-event analysis. Length of hospital stay and discharge destination were secondary outcomes.</p><p><strong>Results: </strong>Sarcopenia was independently associated with increased mortality at 30 days (adjusted OR 3.88, 95% CI 1.83 to 8.22) and 90 days (adjusted OR 3.75, 95% CI 2.22 to 6.35). Cox regression similarly demonstrated increased 90-day mortality hazard (adjusted HR 3.19, 95% CI 2.01 to 5.06). No significant associations were observed between sarcopenia and length of hospital stay (median 13.27 vs. 13.25 days; p = 0.930) or discharge destination (χ²= 1.63, p = 0.202).</p><p><strong>Conclusion: </strong>CT-defined sarcopenia was independently associated with early mortality, supporting its potential role as an opportunistic marker of postoperative risk.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric supracondylar humeral fractures: Does pin and splint removal 3 weeks after surgery increase the risk of secondary displacement?","authors":"Andreas Tsoupras, Viola Sbampato, Johanne Mazurié, Ardian Ramadani, Giacomo De Marco, Romain Dayer, Oscar Vazquez, Dimitri Ceroni, Anne Tabard-Fougère, Christina Steiger","doi":"10.1007/s00590-026-04985-7","DOIUrl":"https://doi.org/10.1007/s00590-026-04985-7","url":null,"abstract":"<p><strong>Purpose: </strong>Supracondylar fractures of the distal humerus are among the most common pediatric fractures. For unstable fractures, reduction with pin fixation and postoperative immobilization is standard, but the optimal duration of pin fixation and splinting remains uncertain. This study evaluated whether pin and splint removal approximately 3 weeks after surgery was associated with secondary fracture displacement in children treated for displaced supracondylar humeral fractures.</p><p><strong>Methods: </strong>We retrospectively reviewed pediatric patients surgically treated for displaced supracondylar humeral fractures at our institution between January 2015 and December 2024. Both closed and open reduction cases were eligible. Collected data included demographics, Rigault-Lagrange fracture stage, fixation construct, duration of pin and splint immobilization, radiographic displacement before and after removal, and postoperative complications.</p><p><strong>Results: </strong>A total of 211 patients were included (mean age 6.5 ± 2.3 years). According to the Rigault-Lagrange classification, 87 fractures were stage 2, 54 were stage 3, and 70 were stage 4. Pins and splints were removed after a mean of 23.6 ± 4.0 days. Secondary radiological displacement was observed in 11 patients, corresponding to 13 displacement events: 10 occurred before pin removal and 3 after removal. Three patients showed a change in Baumann's angle greater than 12° after removal, and no patient lost intersection of the anterior humeral line with the capitellar ossification center after removal. One patient required early revision before pin removal, and no patient required delayed corrective osteotomy.</p><p><strong>Conclusion: </strong>In this retrospective cohort, pin and splint removal approximately 3 weeks after surgical fixation of pediatric supracondylar humeral fractures was associated with a low rate of subsequent secondary displacement, irrespective of fracture stage. Most displacement events occurred before pin removal, and no patient required delayed corrective osteotomy. Early removal may limit exposure to complications associated with prolonged pin fixation and immobilization, although this potential benefit requires confirmation in comparative studies.</p><p><strong>Level of evidence: </strong>III (retrospective cohort study).</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative NSAID use and postoperative outcomes after distal radius fracture surgery: a propensity-matched cohort study.","authors":"Arjun Dinesh, Sandra Fahmy, Mohammad Poursalehian, Youssra Marjoua, Cesar Cereijo, Damien Billow, Ronald Peirish, Anokha Padubidri, Joseph Styron, Heather Vallier","doi":"10.1007/s00590-026-04980-y","DOIUrl":"https://doi.org/10.1007/s00590-026-04980-y","url":null,"abstract":"<p><strong>Purpose: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management following distal radius fracture (DRF) surgery, yet their effects on postoperative complications remain unclear. This study evaluated the association between perioperative prescriptive NSAID use and surgical and medical complications following DRF surgery.</p><p><strong>Methods: </strong>A retrospective cohort study using the TriNetX database identified adult patients who underwent DRF surgery between 2012 and 2024. Patients were categorized based on NSAID prescription within 1 day before to 1 month after surgery. Propensity score matching controlled for demographic variables. Primary outcome was 1-year surgical complications (malunion/nonunion surgery, postoperative infection, and revision surgery). Secondary outcomes included 90-day medical complications (myocardial infarction, gastrointestinal bleeding, acute kidney injury, emergency department visits, and readmission). Statistical analyses included Kaplan-Meier survival analysis and Cox proportional hazards regression.</p><p><strong>Results: </strong>Among 76,913 patients identified, 30,760 matched pairs were analyzed. The primary outcome of malunion/nonunion surgery at 1 year showed no significant difference after matching. At 1 year, NSAID prescription patients had significantly higher rates of postoperative infection and revision surgery. Within 90 days, NSAID prescription patients demonstrated higher emergency department visit rates but no significant differences in myocardial infarction, gastrointestinal bleeding, acute kidney injury, or readmission.</p><p><strong>Conclusions: </strong>Despite statistically significant increases in postoperative infections, revision surgery, and emergency department visits, absolute risk differences were modest (less than 1% for all outcomes). No significant difference was observed in the primary outcome of malunion/nonunion surgery, and this null finding persisted across sensitivity analyses restricted to nonselective NSAIDs and to a 1-week exposure window. Given the small absolute risk differences observed and the effectiveness of NSAIDs for pain control, these findings suggest that perioperative NSAID use is not associated with a clinically meaningful increase in fracture nonunion, though the modest increases in infection and revision surgery warrant individualized risk-benefit discussion, particularly in patients with additional risk factors for these complications.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the posterior pelvic ring during examination under anesthesia changes surgeons' classification and treatment decisions of anterior posterior compression pelvic ring injuries.","authors":"Camryn C Therrien, Kaj Ten Duis, Alessandro Aprato, Hester Banierink, Umberto M R Mezzadri, Henry C Sagi, Jean-Paul P M de Vries, Inge H F Reininga, Frank F A IJpma","doi":"10.1007/s00590-026-04930-8","DOIUrl":"10.1007/s00590-026-04930-8","url":null,"abstract":"<p><strong>Purpose: </strong>Traditionally, examination under anesthesia (EUA) focuses on displacement of the anterior pelvic ring and may fail to detect or localize sacroiliac (SI) joint diastasis in patients with anterior-posterior compression (APC) pelvic injuries. This study evaluates the effect of directly observing sacroiliac (SI) diastasis during EUA, compared to observing only the anterior pelvic ring (AP EUA), on changes in classification and treatment plan.</p><p><strong>Methods: </strong>Four hundred international pelvic surgeons were invited to participate in an online survey, with one month between two surveys. All surveys included the same 10 cases of APC injuries. One part included AP EUA images, and the other included additional SI EUA images. Questions regarding classification and treatment were asked, including the need for anterior and posterior fixation, and the side of SI joint fixation. The change in management after the addition of SI EUA images was assessed.</p><p><strong>Results: </strong>One hundred six pelvic trauma surgeons completed the survey with AP EUA images, and 99 also completed the survey with SI EUA images. The addition of SI EUA imaging resulted in a 37% change in classification, with APC1 decreasing from 17% with AP EUA to 10% with SI EUA, APC2 remaining 67%, and APC3 increasing from 17 to 23%. Treatment decisions changed in 29% of all cases. There was an increase in the combined anterior and posterior fixation, from 56 to 74%. Improved lateralization (choice of right or left SI joint fixation) was seen in 4 cases.</p><p><strong>Conclusion: </strong>In this survey, the addition of SI EUA images according to the modified protocol changed surgeons' perception of pelvic ring instability and the subsequent treatment strategy chosen. SI EUA images provide surgeons with information that prompts the addition of an SI joint fixation, resulting in an 18% increase in the use of combined anterior and posterior fixation. SI EUA images also improved injury localization, helping surgeons identify which sacroiliac joint required stabilization.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Functional and quality of life outcomes after tibialis posterior transfer for foot drop from peroneal nerve injury.","authors":"Nayab Iftikhar","doi":"10.1007/s00590-026-04967-9","DOIUrl":"10.1007/s00590-026-04967-9","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of clinical and sociodemographic variables in development of acute compartment syndrome requiring fasciotomy after tibia fractures.","authors":"Doriann Alcaide, Nicholas Andrews, Gerald McGwin, Clay Spitler, Joseph Johnson","doi":"10.1007/s00590-026-04974-w","DOIUrl":"10.1007/s00590-026-04974-w","url":null,"abstract":"<p><strong>Background: </strong>Factors like age, sex, high-energy trauma, and complex fractures are factors for acute compartment syndrome (ACS), but the influence of sociodemographic factors remains unexamined. The goal was to assess whether sociodemographic factors were independently associated with ACS requiring fasciotomy after tibia fracture when accounting for available clinical and injury-related factors.</p><p><strong>Methods: </strong>This is a retrospective study of patients diagnosed with tibia fractures between 2016 and 2021 using the Nationwide Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population. The primary outcome was the rate of ACS requiring fasciotomy.</p><p><strong>Results: </strong>A total of 118,769 patients were identified (weighted N = 593,845), with 2.51% (14,880) diagnosed with ACS requiring fasciotomy. There was a non-significant decrease in the rate of ACS from 2016 to 2021 (2.63% vs. 2.29%, p = 0.065). Patients with ACS requiring fasciotomy had higher hospital charges ($242,160 vs. $117,557; p < 0.001), rates of inpatient mortality (2.1% vs. 1.6%; p = 0.012) and longer length of stay (12.8 days vs. 7.03; p < 0.001). Younger age (41.6 vs. 51.4; p < 0.001), male sex (3.59% vs. 1.23%; p < 0.001), non-whites (2.87% vs. 2.31%; p < 0.001), Hispanic ethnicity (2.87% vs. 2.46%; p = 0.005), operative treatment of tibia (5.87% vs. 2.26%; p < 0.001), concurrent fibula fracture (3.19% vs. 2.06%; p < 0.001), private insurance (2.88% vs. 2.32%; p < 0.001) and hospital transfer (3.12% vs. 2.40%; p < 0.001) were associated with higher rates of ACS on bivariate analysis. Multivariate analysis showed that older age (OR = 0.288, p < 0.001) and female gender (OR = 0.430, p < 0.001) decreased risk while surgical treatment (OR = 2.358, p < 0.001) increased the risk for ACS.</p><p><strong>Conclusion: </strong>While sociodemographic factors have some influence in the development of ACS in patients with tibia fractures, clinical factors-like age, gender and surgical management-have a stronger influence and should primarily guide clinical suspicion and decision-making.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of cannabis use disorder with clinical outcomes following lumbar spinal fusion: a propensity-matched cohort study.","authors":"Stephen Cave, Robert J Ferdon, Charles L Shissias, Robert A Ravinsky, Charles A Reitman, Jason Silvestre","doi":"10.1007/s00590-026-04977-7","DOIUrl":"10.1007/s00590-026-04977-7","url":null,"abstract":"<p><strong>Purpose: </strong>Cannabis use disorder (CUD) has become increasingly prevalent, yet its association with postoperative outcomes after spine surgery remains poorly characterized. Given the physiologic effects of cannabinoids on pain modulation, inflammatory signaling, and bone metabolism, CUD may be associated with differences in perioperative recovery and spinal fusion outcomes. The purpose of this study was to evaluate the association between a coded preoperative diagnosis of CUD and clinical outcomes following lumbar spinal fusion.</p><p><strong>Methods: </strong>We conducted a retrospective, propensity-matched cohort study using a multi-institutional electronic medical record database. Patients undergoing single- and multi-level lumbar spinal fusion during the ICD-10-CM era were identified and stratified by a documented preoperative diagnosis of CUD (ICD-10-CM F12) within a 1-year preoperative look-back window (primary analysis). Controls without CUD were matched 1:1 on 37 demographic and clinical covariates. Matched-pair methods were used for outcome comparison, and unadjusted P values were interpreted after Holm-Bonferroni sequential correction.</p><p><strong>Results: </strong>After propensity matching in the primary (1-year look-back) analysis, the single-level cohort comprised 1266 patients with CUD and 1266 matched controls per arm (1251 per arm at the 2-year horizon), and the multi-level cohort comprised 1086 patients with CUD and 1086 matched controls per arm (1071 per arm at 30 days). At 30 and 90 days, patients with CUD did not demonstrate a consistent increase in coded medical complications after correction for multiple comparisons. Patients with CUD had significantly higher rates of documented opioid prescription orders and inpatient readmission in both cohorts. Emergency department (ED) utilization was significantly higher only in the single-level cohort, and behavioral/psychological service utilization was significantly higher only in the multi-level cohort at 90 days. At 2- and 5-year follow-up, patients with CUD demonstrated similar rates of coded pseudarthrosis, subsequent lumbar procedures, and reoperation components compared with matched controls. No long-term outcome remained significant after correction.</p><p><strong>Conclusion: </strong>A coded preoperative diagnosis of CUD was not associated with a consistent increase in short-term perioperative morbidity following lumbar spinal fusion but was associated with higher postoperative healthcare utilization, including documented opioid prescription orders and inpatient readmission. These associations may reflect underlying psychosocial complexity and healthcare-access factors rather than a direct pharmacologic effect of cannabis. Prospective studies incorporating detailed exposure metrics are warranted.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}