Complications of open reduction and internal fixation of ankle fractures in patients with positive urine drug screen.

We conducted a study to identify complications associated with open treatment of ankle fractures in patients who tested positive for illicit drugs on urine drug screen (UDS). We hypothesized that patients who had a history of positive UDS and underwent open reduction and internal fixation of an ankle fracture would have a higher incidence of major and minor complications. We retrospectively reviewed the cases of 142 patients who had surgical stabilization of an ankle fracture during a 3-year period. Patients with a history of positive UDS were compared with matched controls with negative UDS. Outcomes measures included nonunion, malunion, and superficial or deep infection. Fisher exact test, Wilcoxon rank sum test, and univariate logistic regression were used to determine statistical significance. There were no significant differences in age, sex, fracture type, incidence of diabetes, or incidence of open fracture between the groups. Incidence of nonunion was higher in patients with positive UDS (P = .01), as was incidence of deep infection (P = .05). Incidence of pooled major complications was also higher in positive UDS patients (P = .03). Patients with a history of illicit drug use, as evidenced by positive UDS, are at increased risk for perioperative complications during treatment for ankle fracture.