Marijuana Use in Patients with Orthopaedic Trauma- A review

The use of cannabis and cannabis-related products has increased dramatically in the last 2 decades. As states continue to legalize cannabis products, it is important for surgeons to understand the effects they may have on patients who have sustained orthopaedic trauma.

Sean G. Sheppard, MD et Al at  University of California San Diego School of Medicine, University of California San Diego, have evaluated the effects of marijuana use in patients with orthopedic trauma and the same have appeared in the journal of Bone and joint surgery as a review.

Cannabis use is a subject of much interest as it is being used with increasing regularity on both a recreational and medical basis. With increasing legalization across the states and thus lessened legal ramifications, marijuana use will be seen frequently, with patients more likely to endorse it as a treatment. The question for the orthopaedic surgeon is how to counsel patients and other physicians regarding injury and coinciding marijuana use. Patients who have sustained orthopaedic trauma are unique in that rehabilitation is multimodal and variables other than fracture healing must be taken into account.

TBI and PTSD following major trauma can be debilitating and have a high prevalence. While human studies on the effects of marijuana use on TBI and PTSD are lacking, some have shown improvement in symptoms. The review has enumerated several effects of marijuana in cases of orthopaedic trauma.

Marijuana use is common among patients who have sustained orthopaedic trauma and, due to the large number of physiologically active components, it can have a wide array of effects in the body.

» Cannabinoids have been shown to decrease the severity of certain symptoms related to traumatic brain injury(TBI) as well as posttraumatic stress disorder.

A phase-II randomized controlled trial (RCT) was performed among patients with TBI who received dexanabinol (HU-211). Treatment with HU-211 resulted in a reduction in intracranial pressure, cerebral perfusion pressure, and systolic blood pressure in the early-phase rehabilitation period.

In phase-III trials, treatment with dexanabinol failed to result in any significant difference in outcome at 6 months after injury compared with a placebo group. Much research is needed in the realm of TBI.

» The endocannabinoid system plays an important role in bone homeostasis, and constituents of marijuana can modulate this system, including its effect on bone. The current data indicate that activation of the CB1 and CB2 receptors are bone-protective in adults.

» Venous thromboembolism is a major concern for trauma patients. Cannabis use has been linked to overall increased rates of venous thromboembolism events.

» Literature regarding human-based cannabis studies is sparse; however, the growing field is opening new opportunities for research of this topic.

The authors believe that the review may provide clinicians with a concise summary of the available literature that can be used for patient counseling.

Further reading :

Effects of Marijuana Use in Patients with Orthopaedic Trauma. Sean G. Sheppard, MD et al

Investigation performed at the University of California San Diego School of Medicine, University of California San Diego, San Diego, California

JBJS REVIEWS 2021;9(12):e21.00137 • http://dx.doi.org/10.2106/JBJS.RVW.21.00137