Impact of Methamphetamine Use on Injury Characteristics and Postoperative Outcomes in Upper Extremity Fractures

Methamphetamine use in orthopedic trauma carries an indeterminate risk, with prior studies suggesting increased rates of deep vein thrombosis and elevated mortality. Upper extremity fractures (UEFs) have distinct mechanisms of injury and operative risk. This study evaluates outcomes following operative management of UEFs in patients with and without documented methamphetamine use.

A retrospective chart review was conducted of adults undergoing surgical fixation of UEFs (distal radius/ulna to clavicle; phalangeal, metacarpal, and carpal fractures were excluded) from January 2022 to March 2025. Outcomes included urinary tract infection, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, emergency department (ED) visits, readmission, surgical site infection, hardware removal, and mortality. A post hoc subgroup analysis of isolated UEFs was performed.

There were 426 patients meeting study criteria: 40 with methamphetamine use, and 386 without. Methamphetamine users were more likely to experience polytrauma (27.5% vs 10.9%, P = .003), higher-energy injuries (75.0% vs 53.6%, P = .003), interpersonal violence, such as altercations (22.5% vs 5.7%, P < .001), and ED visits within 30 days (20.0% vs 9.1%, P = .047). No other estimable postoperative outcome differed significantly. For isolated UEFs, methamphetamine users had shorter follow-up (85.9 vs 116.3 days, P = .022).

Methamphetamine use was associated with higher-energy injury mechanisms and increased health care use, namely ED visits. No other estimable perioperative complication differed significantly, and no deaths occurred. Operative management should not be withheld solely because of methamphetamine use; targeted case management may reduce postoperative use.