{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:15:38Z","timestamp":1787613338330,"version":"build-2736575974"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>With the widespread legalization and rising prevalence of cannabis use, understanding its impact on perioperative outcomes has become clinically critical. Although recent orthopaedic research has examined cannabis-related risks following various procedures, its implications following surgical fixation of ankle fractures remain unexplored. Given the increasing incidence and complexity of ankle fractures, clarifying these risks is essential for effective perioperative management and patient counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort analysis was conducted using a nationally representative research database. Patients undergoing open reduction and internal fixation (ORIF) for rotational ankle fractures were identified using standardized\n                      <jats:italic toggle=\"yes\">Current Procedural Terminology<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">CPT<\/jats:italic>\n                      ) codes and stratified by preoperative active cannabis use. Propensity score matching (PSM) was used to control for 27 demographic and clinical confounders; data were drawn from the TriNetX Research Network; postmatch balance is reported. Outcomes assessed included medical complications and health care utilization at 90\u2009days and 6\u2009months, and surgical outcomes at 3\u2009years postoperatively. Relative risks (RRs) with 95% confidence intervals were calculated. To account for multiple testing across 34 outcomes, a Bonferroni correction was applied, with statistical significance defined as\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0015.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      After PSM, 3126 matched pairs were included in the analysis. At 90\u2009days postoperatively, cannabis use was significantly associated with increased risks of postoperative infection (RR\u2009=\u20091.696, 95% CI\u202f1.230-2.337,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), wound dehiscence (RR\u2009=\u20091.781, 95% CI\u202f1.268-2.502,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and inpatient readmissions (RR\u2009=\u20091.724, 95% CI\u202f1.221-2.435,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). These associations persisted at 6\u2009months, including elevated risks of postoperative infection (RR\u2009=\u20091.745, 95% CI\u202f1.304-2.337,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), sepsis (RR\u2009=\u20092.847, 95% CI\u202f1.477-5.488,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and hardware infection (RR\u2009=\u20091.944, 95% CI\u202f1.291-2.929,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). At 3\u2009years, the cannabis-use cohort was associated with significantly increased risks of nonunion (RR\u2009=\u20092.308, 95% CI\u202f1.207-4.413,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and reoperation (RR\u2009=\u20092.168, 95% CI\u202f1.353-3.475,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). No significant differences were observed for other measured outcomes following Bonferroni adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Preoperative cannabis use is associated with significantly increased complications following ankle ORIF, notably systemic and hardware infections, nonunion, and reoperation. These findings support recognizing cannabis use as a potentially modifiable perioperative risk factor, akin to tobacco use, underscoring the importance of targeted counseling and strategies aimed at optimizing surgical and patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007251385971","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T06:47:34Z","timestamp":1763362054000},"page":"43-51","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8090-4575","authenticated-orcid":false,"given":"Sri","family":"Tummala","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA"},{"name":"Texas A&amp;M College of Medicine, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7336-9944","authenticated-orcid":false,"given":"Brandon A.","family":"Wood","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8837-0396","authenticated-orcid":false,"given":"Mehul M.","family":"Mittal","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7074-9197","authenticated-orcid":false,"given":"Senthil N.","family":"Sambandam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3637-6208","authenticated-orcid":false,"given":"Dane K.","family":"Wukich","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA"},{"name":"Department of Prosthetics and Orthotics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B6.32721"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-018-0019-y"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/OI9.0000000000000175"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.3254"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007231189698"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-23-00407"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006785"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2016.11.017"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640009352882"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14581"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.1858"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2024.02.003"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00832-3"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10101909"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01088"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.2545"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e318213f217"},{"key":"e_1_3_2_19_2","unstructured":"NIDA. 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Accessed June 10 2025. https:\/\/nida.nih.gov\/news-events\/news-releases\/2022\/08\/marijuana-and-hallucinogen-use-amongyoung-adults-reached-all-time-high-in-2021"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2024.117035"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.04.015"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.2403"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.1.000023"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms221910243"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2021.120018"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-104013"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2018.03.050"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.07.034"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004768"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.07.008"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-04161-y"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(01)00614-7"}],"container-title":["Foot &amp; Ankle International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007251385971","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10711007251385971","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007251385971","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:23:53Z","timestamp":1777411433000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10711007251385971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,16]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/10711007251385971"],"URL":"https:\/\/doi.org\/10.1177\/10711007251385971","relation":{},"ISSN":["1071-1007","1944-7876"],"issn-type":[{"value":"1071-1007","type":"print"},{"value":"1944-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,16]]}}}