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Purpose The purpose of this study was to determine the accuracy of self-reported non-smoking status in subjects undergoing elective orthopedic surgery as confirmed by serum cotinine levels. Methods Institutional Review Board approval was obtained for this retrospective review of consecutive subjects that underwent elective orthopedic surgery by a single fellowship-trained orthopedic surgeon. All patients provided smoking history (active, former, or non-smoker). Serum cotinine levels defined each subject as “non-smoker”, “passive tobacco exposure”, or “active smoker”. Self-reported non-smokers were eligible for inclusion. Subjects were excluded if they failed to provide smoking history, reported themselves as “smokers”, and/or had unavailable serum cotinine levels. Self-reported non-smoking status accuracy was determined by dividing the total number of included subjects by the number of subjects that were defined as “non-smoker” or “passive tobacco exposure” on their serum cotinine test. Results A total of 378 patients (mean age of 42.5 (13-78) years and 68% female) self-reported as non-smokers and were included. A total of 369 subjects had serum cotinine levels consistent with “non-smoking” resulting in a self-reported non-smoking status accuracy of 97.6%. None of the former smokers had cotinine levels consistent with active smoker status. Conclusion Subjects undergoing elective orthopedic surgery self-report as non-smokers with an accuracy of 97.6%. This suggests that routine serum cotinine testing of non-smokers in this patient population may not be necessary.

To determine the efficacy of mandatory preoperative nicotine cessation on postoperative nicotine use, and to identify independent predictors of nicotine use relapse in subjects undergoing hip preservation surgery or total hip arthroplasty by a single fellowship-trained orthopedic surgeon. MethodsConsecutive subjects that underwent hip surgery from November 2014 to December 2017 were reviewed. Subjects who self-reported nicotine use, quit prior to surgery, and completed a minimum one-year follow-up were included. Multiple linear regression models were constructed to determine the effect of independent variables on nicotine use relapse following surgery. ResultsSixty subjects were included in the study (mean follow-up 35.1 months (17-57 months), mean age 44.9 years (20-82 years), and 23 (38.3%) males). Twenty-eight subjects (46.7%) remained nicotine-free at final followup. The mean number of cigarettes per day decreased from 13.4 preoperatively to 8.4 postoperatively in the subjects who relapsed (P=0.002). The mean time to return to nicotine postoperatively was 2.4 months. The number of preoperative cigarettes per day was the only independent predictor of tobacco use relapse (P=0.005). ConclusionMandatory preoperative nicotine cessation prior to elective hip surgery demonstrates a 46.7% nicotine-free survivorship at final follow-up with the number of preoperative cigarettes per day found to be the only independent predictor of nicotine use relapse. Level of evidenceThe level of evidence of this research study is Level III since it is a non-experimental study with a cohort of patients.

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Background Management of distal femur fractures can be challenging, particularly in the aged female population. This retrospective study aims to analyze the surgical outcomes of aged female patients with non-periprosthetic distal femur fractures treated with a locking plate. Methods This is an IRB approved retrospective review conducted at a level 1 trauma center. Fifty-five female patients (mean age of 71 years) with non-periprosthetic distal femur fractures underwent open reduction internal fixation using a locking plate from 2005 to 2019. The average follow-up time was 67 weeks from the date of injury. Criteria used for diagnosis of nonunion included one or more of the following: (I) three consecutive months without progression of healing on postoperative radiographs, (II) a total of nine months postoperative without complete healing, or (III) the physician diagnosed nonunion using clinical judgement. Outcome data was analyzed and compared amongst patients with and without obesity or diabetes. Statistical analysis was performed utilizing Microsoft Excel 2022 Data Analysis ToolPak with a standard statistically significant P value of <0.05. Results Thirty-two patients (58%) with distal femur fractures achieved union after initial treatment while 23 patients (42%) were diagnosed with nonunion. Fourteen patients (61%) underwent revision with 9 of these patients (64%) achieving union while 5 patients (36%) had persistent nonunion. Average healing time from initial treatment to union was 29 weeks, while average time from definitive treatment to union was 22 weeks. Obese patients [body mass index (BMI) >30 kg/m 2 ] had a nonunion rate of 65%, while non-obese patients had a nonunion rate of 28%. Patients with diabetes had a nonunion rate of 65%, while patients without diabetes had a nonunion rate of 28%. Conclusions Union can be successfully achieved in aged female patients with distal femur fractures treated with locking plates; however, the risks for nonunion and revision remain high. Patients with obesity and diabetes appear to be at an increased risk of nonunion (P=0.008 and 0.008, respectively). However, further research should be conducted with a prospective study or multivariate analysis and increased number of patients to reaffirm this data.