# Illicit drug abuse and complexity of tibial shaft fracture based on AO/OTA classification: Is there any connection?

## TL;DR

This study finds that illicit drug abuse is linked to more severe tibial shaft fractures compared to non-users.

## Contribution

The study is among the first to show a significant association between illicit drug abuse and increased severity of tibial shaft fractures.

## Key findings

- Drug abusers had a 76.9% rate of complex fractures compared to 50.3% in non-users.
- Illicit drug abuse was identified as an independent risk factor for complex tibial shaft fractures.
- The association remained significant after adjusting for other variables like smoking and BMI.

## Abstract

Illicit drug abuse is a global epidemic afflicting millions worldwide. Several studies have investigated the contribution of this dependence as a risk factor for fracture, but its impacts on fracture severity have been rarely studied. The present study primarily aims to determine the relationship between illicit drug abuse and the severity of tibial shaft fractures.

This retrospective study consecutively included patients aged ≥18 years with tibial shaft fracture who attended Sina Tertiary Hospital, Tehran, Iran, between 2016 and 2021. The fracture patterns were assessed according to the Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association classification. Participants were divided into three individual specialists into groups: simple (A), wedge (B) and multifragmentary (C) fractures. The association of illicit drug abuse and other recorded variables, including age, sex, body mass index (BMI), comorbidities, physical activity, smoking habits and mechanism of injury, was also examined and assessed in multivariate logistic regression.

Of 219 patients, 26 were drug abusers, and 193 had no history of use. A total of 20 out of 26 drug abusers experienced a complex fracture, yielding a rate of 76.9%, while this rate for nonusers was 50.3% (97 out of 193), indicating a statistically significant difference between the two subgroups (p = 0.011). The smoking history also influenced the fracture pattern (p = 0.027) based on univariate analysis; however, using adjusted multivariate analysis yielded only illicit drug abuse (odds ratio = 3.495; confidence interval = 1.144–10.680) as a risk factor for more complex fractures.

The evidence from this study suggests that complexity and fracture patterns can depend on illicit drug abuse history.

Level III.