Methamphetamines Adding Fuel to the Orthopedic Fire
by Elizabeth Hofheinz, M.P.H., M.Ed.
“Ice,” “blue,” “crystal,” or “meth”…whatever you call it, methamphetamines (MAs) can heap problems on top of problems for orthopedic patients, says new work from the Keck School of Medicine of the University of Southern California and Cedars Sinai Medical Center, both Los Angeles.
The study, “Complications of Methamphetamine Use in Orthopaedic Trauma,” appears in the October 2020 edition of the Journal of Orthopaedic Trauma. Co-author Geoffrey Marecek, M.D., is with the Department of Orthopaedic Surgery at Cedars Sinai Medical Center in Los Angeles. He told OSN, “We saw a LOT of patients who used methamphetamine and heard the same from our colleagues at other hospitals. However, the only information out there about how common this was, or how it affected the results of their injuries was related to perioperative concerns about cardiac function. We decided to look at the scope of the problem (which was published in JAAOS earlier this year) and then to see how these patients actually fared after their injuries.”
The team assessed all fractures for which an orthopaedic consult was placed in the emergency department at a level one trauma center—Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California—in 2016. In the final analysis, there were 2483 fracture patients, of whom 189 were methamphetamine users.
“Patients who used methamphetamine were more likely have a DVT [deep vein thrombosis], leave the hospital against medical advice or be lost to follow up,” said Dr. Marecek to OSN. “Probably more importantly, there was a trend toward higher complication rates with methamphetamine use.”
The team found that not only was the MA group significantly more likely to use tobacco, alcohol, and illicit drugs, and be homeless, they were significantly more likely to have polytrauma. They did not find an increased rate of infection among individuals who use methamphetamines. They wrote, “This finding is unexpected, given basic science studies have demonstrated that MA adversely impacts certain components of the immune system…”
“Perhaps most interestingly,” Dr. Marecek told OSN, “was the definite trend toward nonunion in methamphetamine users, though our study was definitely underpowered to detect this difference. Hopefully in future studies we can explore this relationship more.”
“Surgeons should be aware of the association between methamphetamine use and nonadherence to weightbearing protocols; ensuring proper DVT prophylaxis and creating constructs that can withstand early weightbearing can hopefully prevent longer term issues from these problems. But they should also recognize that most of the complication rates were similar and do not change much in terms of risk assessment when dealing with these patients.”