Tobacco use and complications after open reduction and internal fixation of distal radius fractures in older adults: A propensity score-matched analysis.

BackgroundDistal radius fractures (DRFs) are among the most common fragility-related fractures in older adults. Although open reduction and internal fixation (ORIF) is often selected to restore function and enable early mobilization, preoperative risk factors such as tobacco use may impair bone metabolism and immune function, affecting ORIF outcomes. This study aimed to investigate 90-day and 2-year outcomes after DRF ORIF in geriatric patients with a history of tobacco use or nicotine dependence.MethodsA retrospective cohort analysis was performed using a nationwide database to identify patients aged ≥60 years who underwent DRF ORIF with at least two-year postoperative follow-up between 2005-2025. Patients were categorized into tobacco users and controls. Propensity score matching (1:1) was applied for demographics and major comorbidities. Primary outcomes included implant removal, malunion/nonunion repair, and infection at two years postoperatively; secondary outcomes encompassed ninety-day medical systemic complications.ResultsAfter matching, 5,725 patients remained in each cohort. Tobacco users had higher rates of sepsis (0.2% vs 0%, p=0.002), renal failure (RR 2.64, p=0.001), pneumonia (RR 2.64, p<0.0001), wound complications (RR 1.62, p=0.004), and postoperative infection (RR 2.46, p<0.0001). At two years, rates of malunion/nonunion repair (RR 2.08, p=0.001) and malunion (RR 1.54, p=0.042) remained significantly elevated.ConclusionA history of tobacco use is associated with increased 90-day and 2-year complications after ORIF for DRF in older adults. These findings highlight the importance of preoperative counselling, smoking cessation, and perioperative optimization to improve surgical outcomes in this population. Further research is needed to identify targeted interventions and strategies to reduce these complications and improve recovery in older adults with a history of tobacco use.