Objective:To identify the impact of marijuana use on fracture healing in surgically treated pediatric patients.Design:Retrospective review.Setting:Level 1 trauma center, single-center study.Patients/Participants:Surgically treated pediatric patients 10–18 years with extremity fractures from 2010 to 2020. Conservatively treated patients and patients with nonunions were excluded from the study. Three hundred thirty-nine patients were included in the study, 21 of which were confirmed marijuana users by toxicology screening.Intervention:Surgical treatment of extremity fractures by any type of fixation.Main Outcome Measurements:Time to union was the primary outcome and was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line. Analysis of covariance, logistic regression analysis, and Fisher exact tests were used to establish the relationship between all collected variables and time to radiographic union.Results:The average time to union for marijuana users (159.1 ± 69.5 days, 95% confidence interval) was significantly longer than for nonusers (80.3 ± 7.8 days), P < 0.001. The odds of having a time to union of greater than 4 months and greater than 6 months were 4.17 (P = 0.00192) and 6.19 (P = 0.000159), respectively, for marijuana users compared with nonusers.Conclusion:Marijuana users demonstrated longer time to union in surgically treated pediatric fracture patients.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Purpose To develop a method for using an intact posterior cruciate ligament (PCL) as a predictor of anterior cruciate ligament (ACL) graft size and examine possible differences in tunnel length based on all-epiphyseal drilling method. Methods One hundred one patients 5–18 years of age with magnetic resonance imaging (MRI) of the knee at an outpatient pediatric orthopaedic clinic from 2008 to 2020 were included. ACL and PCL coronal, sagittal, and length measurements were made in all patients. Tunnel length measurements were made in patients with open physes. Statistical analyses were performed to evaluate potential associations in patient bony or ligamentous measurements. Results PCL sagittal width and PCL coronal width were statistically significant predictors of ACL sagittal width and ACL coronal width, respectively (p = 0.002, R = 0.304; p = 0.008, R = 0.264). The following equations were developed to calculate ACL coronal and sagittal width measurements from the corresponding measurement on an intact PCL; ACL Coronal Width (mm) = 6.23 + (0.16 x PCL Coronal Width); ACL Sagittal Width (mm) = 5.85 + (0.53 x PCL Sagittal Width). Mean tibial maximum oblique length (27.8 mm) was longer than mean tibial physeal sparing length (24.9 mm). Mean femoral maximum oblique length (36.9 mm) was comparable to mean femoral physeal sparing length (36.1 mm). Both were longer than mean femoral straight lateral length (32.7 mm). Conclusion An intact PCL is a predictor of native ACL size. Tunnel length differs based on chosen drilling method in all-epiphyseal technique. Level of evidence Diagnostic Level III.

Marijuana use is on the rise in the United States, and there is a paucity of information on the effects of cannabis and its chemical constituents on bone health, wound-healing, surgical complications, and pain management.Current evidence suggests that cannabidiol (CBD) may enhance bone health and metabolism, while Δ9-tetrahydrocannabinol (Δ9-THC), the major psychoactive component in marijuana, has an inhibitory effect.Marijuana users are at higher risk for delayed bone-healing, demonstrate lower bone mineral density, are at increased risk for fracture, and may experience postoperative complications such as increased opioid use and hyperemesis.

Introduction: To determine whether obesity affects time to radiographic union in surgically treated pediatric extremity fractures. Methods: A retrospective review of pediatric patients with extremity fractures at a Level 1 trauma center from 2010 to 2020. Those treated conservatively and patients with nonunions were excluded. Union was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line. Results: Obese patients had a markedly increased time to union when compared with others, even when age, sex, fracture type, race, and ethnicity were controlled for. The mean time to union for obese and nonobese patients were 152 and 93.59 days, respectively ( P < 0.001). Obese patients had 3.39 times increased odds of having increased time to union. Obese patients had 6.64 times increased odds of having fractures with delayed union of 4 months or greater ( P < 0.001). Conclusions: There is a positive correlation between obesity and time to union in surgically treated pediatric fracture patients.