{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:10:04Z","timestamp":1791288604706,"version":"4.3.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To examine postoperative complication rates in patients with nicotine dependence compared with nonusers to clarify the risks in pilon fracture recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Data from the TriNetX Health Research Network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA\/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and nondependent groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>\n                      Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      After propensity score matching (N = 4371 patients in each cohort), the mean age was 44.4 \u00b1 14.5 years in cohort 1 and 44.7 \u00b1 15.7 years in cohort 2. Female patients comprised 34.9% of cohort 1% and 35.3% of cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003), malunion\/nonunion (6.3% vs. 4.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), wound disruption (4.5% vs. 3.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), and a higher infection rate (5.7% vs. 3.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003085","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T18:00:28Z","timestamp":1759255228000},"page":"e82-e87","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Nicotine Dependence on Postoperative Outcomes in Pilon Fracture Open Reduction and Internal Fixation: A Comparative Cohort Analysis"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8967-8296","authenticated-orcid":false,"given":"Joshua","family":"Wang","sequence":"first","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon N.","family":"Cambre","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Cho","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie L. M.","family":"Dugan","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishank","family":"Panchbhavi","sequence":"additional","affiliation":[{"name":"The University of Texas Medical Branch, Galveston, TX; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen S.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod K.","family":"Panchbhavi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260213","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1007\/s00264-019-04344-8","article-title":"High-energy tibial pilon fractures: an instructional review","volume":"43","author":"Zelle","year":"2019","journal-title":"Int Orthop"},{"key":"R2-20260213","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.2106\/JBJS.21.01377","article-title":"Management of high-energy tibial pilon fractures","volume":"105","author":"Murawski","year":"2023","journal-title":"J Bone Joint Surg Am"},{"key":"R3-20260213","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/BOT.0000000000002637","article-title":"Reducing complications in pilon fracture surgery: surgical time matters","volume":"37","author":"Shafiq","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R4-20260213","doi-asserted-by":"crossref","first-page":"22s","DOI":"10.1016\/0002-9343(92)90623-J","article-title":"Smoking and wound healing","volume":"93","author":"Silverstein","year":"1992","journal-title":"Am J Med"},{"key":"R5-20260213","doi-asserted-by":"crossref","first-page":"43213","DOI":"10.1038\/srep43213","article-title":"Myofibroblast differentiation and its functional properties are inhibited by nicotine and e-cigarette via mitochondrial OXPHOS complex III","volume":"7","author":"Lei","year":"2017","journal-title":"Sci Rep"},{"key":"R6-20260213","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.injury.2021.10.020","article-title":"Are deep infections that present before and after 90 days from orthopaedic trauma different? 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