Influence of Alcohol Consumption in the Fracture Healing Process

Influence of Alcohol Consumption in the Fracture Healing Process | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influence of Alcohol Consumption in the Fracture Healing Process Virginia MARINA, Florentin DIMOTE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1369914/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study presents the impact of alcohol addiction in the treatment of fractures following alcohol withdrawal. The study was done on patients from the region of Moldova, Romania and admitted to the orthopedics-traumatology department. The Moldavian region of Romania is famous for its wine-growing areas and the quality of its wines (internationally renowned vineyards are: Cotnari, Odobesti, Panciu Husi) and is therefore a region with high alcohol consumption. The study presentation: The study carried out in the orthopaedics-traumatology clinic of the Emergency Clinical Hospital « Sf. Andrei » of Galati, was conducted over a period of 5 years, 2015-2019, on a group of 510 patients. Of the 510 patients admitted, the 215 patients had different types of fractures of the upper limb and the remaining 295 patients had different types of fractures of the lower limb but also fractures of the pelvis. The welded group was composed of the follows: the 435 patients were male and the 75 female. The vast majority of these patients were from the rural areas, 422 patients. In terms of social class, the 35 patients had higher education, the 411 patients had secondary education and the 74 patients had elementary or no education. The most affected age of the patients with the withdrawal syndrome was in the 40-50 age group (131 patients) and 51-60-year-old (203 patients). 88 of the patients were spirits drinkers (especially « ţuică » Romanian spirit drink), 245 of the patients were the wine drinkers, 99 patients were the beer drinkers and 78 patients were the drinkers of any alcoholic beverage. Discussions: Of the 105 patients who developed sudden alcohol withdrawal in the first 48 hours, 35 patients were consumers of any type of alcoholic beverage, 46 patients were the wine drinkers and 24 were the beer drinkers. Due to the rapid onset of withdrawal of the 105 patients, we were able to perform emergency surgery on only the 45 patients, while the remaining the 65 patients developed early alcohol withdrawal, which necessitated a delay in surgery, temporary immobilization of the fracture and subsequent transfer to the psychiatric hospital for the specialized treatment. Of the 65 patients who were transferred, the 30pacients had fractures where the temporary immobilization could be performed. Of the 30 patients who were immobilized in different types of plaster casts, the 15 patients returned with damaged plaster casts or even without immobilization. The alcohol withdrawal generally starts about 48 hours after the abstinence and depends by the social class, the age and the type of alcohol consumed by the patient. The most severe types of the withdrawal were to the patients 51-60 -year-old, from the rural areas with the elementary education and the consumers of wine and beer. To this is added poor nutrition. The patients who were more easily withdrawn were those with higher education, well nourished, mainly consumers of beer or wine. They came out of the withdrawal relatively easily either with less the alcohol consumption or with the vitamin therapy and did not require the transfer to a psychiatric ward. At the opposite end of the spectrum are patients about 50-60 -year-old, from rural areas, who drink 2-3 liters of wine or beer a day, without much education. Conclusion: The patients with the possible decomposition through the alcohol withdrawal should be diagnosed at the admission and treated early with the metabolic support, the vitamin therapy and the hypnotics so that they do not the trigger alcohol withdrawal. In some cases, the delay of the surgery due to the early onset of the withdrawal, the long-term surgical and the functional outcomes have been shown to be unsatisfactory for the patient. addiction alcohol withdrawal agitation fracture Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background: It is known from the old ancestors that the region of Moldova is one of the richest in the vineyards, especially the south of Moldova. Each peasant has a few acres of vines nearby his house and the works them every year, the land producing hundreds of liters of the wine and the « tuica » (Romanian spirit drink), which he consumes for his own interest. In a 24-hour shift we medically examine about the 40 patients with various acute and chronic traumatic conditions. Of these, patients at least 3 patients besides acute traumatic conditions show the specific alcoholic facies accompanied by the alcoholic restlessness and tremor that occurs in a person who has not administered his daily dose of alcohol. Fortunately for us, many of them have acute traumatic conditions that can be treated orthopedically and do not require hospitalization. On the other hand, at the periodic check-up, if they present themselves, they often come with the degraded plaster casts and make from the simple fractures without the displacement, the complex fractures with the secondary degradation and requiring surgery sometimes even with skin lesions due to non-compliance to the therapeutic indications. If we are talking about the lower limb, they come to the outpatient check-up stepping on the plaster devices or they remove them at home for certain reasons, as well as in the case of fractures of the upper limb, most of the times, they come with the degraded or even removed plaster cast. On a weekly basis, we have at least 2 patients of the admitted patients who trigger an alcohol withdrawal in the first 48 hours after admission, which leads us, to delay surgery, requesting the transfer to the psychiatric hospital for the psychomotor stabilization and the specialized treatment and then the patients returned for orthopedic surgical treatment. Introduction: The study was conducted over a 5-year period (2015–2019), on a cohort of 510 patients admitted and operated for various fractures of the upper or lower limb in the Orthopedics and Traumatology clinical department of the Emergency Clinical Hospital "Sf. Andrei" of Galati, who have triggered alcohol with drawl during hospitalization. Of the 510 patients admitted, 215patients had different types of fractures of the upper limb and the remaining 295 patients had different types of fractures of the lower limb and fractures of the pelvis. (Fig. 1 ) The Study Presentation: The structure of the study group is as follows 435 patients were male and 75 patients were female. (Fig. 2 ) The vast majority of them came from the rural areas, 422 patients. In terms of education, the 35 patients had higher education, the 411 patients had secondary education and the 74 patients had elementary or no education. (Fig. 2 ). The patients who presented the withdrawal syndrome were those whose age range was between 40–50 -year-old (131 patients) and between 51–60 -year-old (203 patients). I should mention that 88 of the patients were consumers of alcoholic be averages (spirit drink), 245 of the patients were consumers of wine, the 99 patients were the consumers of beer and 78 patients were the consumers of any alcoholic beverage. Of the 105 patients who developed alcohol withdrawal in the first 48 hours, 35 patients were the drinkers of anything, 46 patients were the wine drinkers and 24 patients were the beer drinkers. (Fig. 4 ). Due to the rapid onset of the withdrawal syndrome to the 105 patients, we were able to perform emergency surgery on 45 patients, while the remaining 65 patients developed early alcohol withdrawal, which required a delay in surgery, a temporary immobilization of the fracture and the subsequent transfer to the psychiatric hospital for specialized treatment. Of the 65 patients who were transferred, the 30 patients had fractures where the temporary immobilization could be performed. Of the 30 patients who were immobilized in different types of plaster casts, the 15 patients returned with damaged plaster casts or even without immobilization of plaster cast. Out of the total number of patients admitted, 405 patients underwent specialist treatment in the ward, these patients developed a milder form of the withdrawal syndrome 60 patients received variable doses of alcohol during admission in the hospital to avoid the onset of withdrawal and 20patients of them developed a milder form of the withdrawal syndrome which recovered in the first 24 hours under drug treatment, hydro electrolytic rebalancing and vitamin therapy, anticonvulsants, adrenergic, anesthetic and sometimes antipsychotic medication. The treatment of the alcohol withdrawal syndrome is complex, both because of the associated co morbidities and the unpredictable evolution that characterizes this syndrome. Although international guidelines recommend pharmacological treatment not only as a solution to alleviate the withdrawal syndrome but also to prevent its evolution, this treatment is in some cases ineffective with disastrous effects for the patient both pre and post-operatively [ 2 , 13 , 15 ]. The aim of the present work is to evaluate the evolution of patients with different types of fractures who develop the alcohol withdrawal syndrome during hospitalization as well as the complications that may occur due to the unpredictable evolution of this syndrome. Out of 215 patients with the fractures of the upper limb, in the first 48 h after admission, 25 patients suffered complications due to the withdrawal syndrome, such as: the 20 patients with the secondary fracture opening; the 4 patients immobilized in plaster casts, had a secondary fracture degradation under plaster casts and the hemorrhagic phlebitis; 1 patient was associated nerve damage. (Fig. 5 ). The most complications were encountered to the patients with the fractures of the lower limb and the pelvis who, due to the personality disorders and the alcoholic dementia, tried to mobilize on the fractured lower limb segment. The 295 patients had such as: the 15 patients had femoral neck fractures, the 163 patients had per trochanteric fractures, the 11 patients had femur fracture, the 37 patients had calf fractures, the 43 patients had ankle fractures, the 12 patients had pelvic fractures, the 14patients had calcaneus fractures. Of the 295 patients, the 65patients suffered various complications, namely:20 patients had a fracture degradation and the secondary hemorrhagic blister; 20 patients suffered skin complications under immobilization with a gypsum cast. 10 of these patients had a closed fracture transformed into an open fracture, (I mention the fracture of the both lower 1/3 leg bones, where initially, a trans calcaneal traction extension was fitted to release the fracture site. Subsequently, those patients developed the hallucinatory syndromes, the alcoholic tremor, the psychomotor agitation, which is why the extension was removed and femoral-pedal immobilization was applied so that they could be transported to the psychiatric department until stabilization and hydro electrolytic balancing. On return, they presented the skin necrosis at the fracture site with the secondary fracture opening) [ 2 ]. Out of all patients: 6 patients had a fracture and the secondary dislocation; 4 patients had the deep vein thrombosis; 3 patients had the pulmonary thromboembolism; 2 patients had the compartment syndrome. In the vast majority of cases, the withdrawal started within 48 hours of admission and of the 65 patients transferred to the psychiatric hospital, only 45 patients could be operated on before the withdrawal declined and then sent to the psychiatric department for stabilization and the other 20 patients were operated on upon return to the orthopedic department. The patients who could be operated on before the onset of withdrawal were additionally immobilized with a gypsum immobilizer for surgical safety and to avoid damage to the fracture as well as to the implant. Of the 45 patients operated on in the first 48 hours, 20 patients were mobilized postoperatively after admission and loaded on the operated limb, which led to fracture and osteosynthesis material degradation, requiring reoperation. Of the 20 patients not operated on and transferred to the psychiatric hospital (Fig. 7): 10 patients returned with fracture degradation and secondary phlyctena, which required in the first phase treatment of the phlyctena(blisters) until stripping and later definitive surgery; 4 patients with secondary open fracture, which meant during 1 surgery (first operative time) provisional until tissue healing and during II definitive surgery; 4 patients with deep vein thrombosis. Of the 405 patients treated in the ward, 10 patients developed the secondary bleeding phlebitis, 5 patients had the deep vein thrombosis, 3 patients had the compartment syndrome, 3 patients developed the pulmonary thromboembolism and 7 patients converted a closed fracture to an open fracture. (Fig. 8 ). Of the 60 patients who received variable doses of alcohol during hospitalization, only 15 patients suffered complications, namely 4 patients had the deep vein thrombosis, 1 patient had the compartment syndrome, 2 patients had the pulmonary embolism and 8 patients had the secondary phlebitis. It should be noted that none of the 35 patients with the higher education had only the alcohol withdrawal syndrome. Those patients had not a withdrawal syndrome with personality disorder and they didn’t need requiring transfer to the psychiatric service. They were given alcohol in small doses, either 50 ml alcohol/day or one glass of wine/day. 11 patients refused alcohol after the first day, and they overcame the withdrawal period with hydration medication and vitamin therapy (4 ampoules of vitamin B1 and B6 intravenous daily). Discussion: A study conducted in March 2019 called "Perioperative Management of the Orthopedic Patient and Alcohol Use, Abuse, and Withdrawal," published in the Journal of the AAOS reports that the acute and the chronic alcohol use is a significant risk factor for orthopedic conditions and postoperative complications. [ 16 ] Returning to our study, we note that the alcohol withdrawal syndrome generally starts about 48 hours after the abstinence and depends on the social class, the age and type of the alcohol consumed by the patient. The most severe withdrawals syndrome was to the patients of the 51–60 age groups, from the rural areas with the elementary education and to the wine and the beer drinkers. This is compounded by poor nutrition. The patients who triggered a milder withdrawal syndrome were those with higher education, well-nourished, mainly consumers of the beer or the wine. They came out of the withdrawal syndrome relatively easily, either with less alcohol consumption or with vitamin therapy and did not require transfer to a psychiatric ward. At the opposite end of the spectrum are patients aged about 50–60 years, from the rural areas, who drink wine or beer, daily, in quantities of 2–3 liters per day, without much education. The patients with fractures of the upper limb had fewer complications, because they could be operated on even after balancing their personality. In contrast, those with fractures of the lower limbs, especially the unoperated ones, needed more laborious surgery because of the degeneration of the fracture during the withdrawal syndrome. The patients to whom, the osteosynthesis was successful before the withdrawal syndrome, in particularly, osteosynthesis of femur and calf fractures with centromedullary implants, also progressed well after the psychotic incidents and did not require further surgery. An early mobilization of the patient with the psychomotor decompensation leads to complication of an unoperated fracture, especially in the lower limb. The choice of the implant is very important. If surgery is performed before the onset of the psychomotor agitation, osteosynthesis should preferably be centromedullary, to allow eventual loading. A patient who will go to the withdrawal syndrome has obvious changes such as: the psychomotor agitation, the sweating, bradycardia, the slurred speech. In addition to this, the anamnesis must include the following questions: « How much you drink per day? What you drink? When you drink? When you last drank? » The patient's condition, the complete history, can direct the doctor towards to a possible crisis that must be alleviated by rapid medication - diazepam to every 2 hours, vitamin therapy in intravenous infusion (4 vials of vitamin B1 and B6), hydration and the psychotropic medication and if the patient's condition allows, firm osteosynthesis of the fracture. To the patients with fractures of the both upper and lower limbs where the fracture had degraded under the plaster cast and the secondary appearance of haemorrhagic phyllodes, daily grooming of the phyllodes was initiated. The necrectomy where necessary and their decapitation until healing after which definitive osteosynthesis was performed. The patients who suffered closed fractures with the secondary opening, benefited from a longer period of hospitalization concomitant with a surgical treatment in several stages, in the first stage was carried out the sanitization of the infectious focus by repeated cultures and targeted antibiotic therapy associated with a provisional osteosynthesis at a distance with external fixture or "k" brose, and then definitive osteosynthesis. Of the 3 patients who developed pulmonary thromboembolism, 2 patients of them developed this condition before surgery and one patient, postoperatively. In all cases, double dose the antithrombotic and prophylaxis was initiated followed by maintenance dose. The deep venous thrombosis, which can often manifest itself by an increase in the volume of the calf, the oedema, the redness and the tenderness in the calf, can always lead to the pulmonary thrombembolism. Through the migration of an embolus of a thrombotic nature, a blood clot, the most frequently coming from the deep veins of the lower limb or pelvis, which can reach the pulmonary arteries. This frequently occurs in patients with fractures of the lower limb or in patients who are bedridden for a prolonged period of time, plus associated co morbidities [ 5 ]. The compartment syndrome of the 2 patients analyzed occurred after a high-intensity crush injury, where emergency intervention was performed to relieve intracompartmental pressure by the fasciotomy, administration of the crystalloid solutions until it subsided. Then the surgical intervention for osteosynthesis of the fracture was done. Conclusion: The patients with the possible decompensation through the alcohol withdrawal syndrome should be diagnosed at admission to the hospital and they must be treated early with the metabolic support, the vitamin therapy and the hypnotics. Also that they didn’t trigger of the alcohol withdrawal syndrome. The alcohol withdrawal syndrome is a dreaded complication of the patients, which develops through the secondary degradation of the simple fractures, by association with the vascular-nervous lesions, the pulmonary thrombembolism and in some cases, even, an osteomyelitis. In some cases, the delay of surgery, due to the early onset of the withdrawal syndrome, the surgical evolution and the long-term functional results have shown to be unsatisfactory for the patient. The correct surgical, and the especially centromedullary fracture, the resolution within the first 48 h after admission of the patients to the hospital who may develop the alcohol withdrawal syndrome, the metabolic support seems to be the optimal solution to decrease the complication rate of these patients. Declarations: Author contribution All authors have revised the article critically for important intellectual content and agreed to the published version of manuscript; they also agreed be accountable for all aspects of this work in ensuring that questions related to the accuracy or integrity of any part of work are appropriately investigated and resolved such as: V.M.–wrote the article and processed the pictures; corresponding author: [email protected] F.D. collected the data and he supervised and treated some of the patients from the study group. Registration of research studies This is a research study. Funding This research received no external funding. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of “Sf. Apostol Andrei” Clinical Emergency Hospital, Galaţi, Romania. (Project identification code : 67/January, 07, 2021)." Informed Consent Statement written informed consent has been obtained from patient to publish this paper. Data Availability Statement informed consent was obtained from all subjects involved in the study. Conflicts of Interest The authors declare that there it is not conflict of interest regarding the publication of this article. References: Campbell’s Operative Orthopedics 13th edition Elsevier 2017 Rockwood and Green’s Fractures in Adults Lippincott Williams & Wilkins 2010 Compendiul de ortopedie traumatologie – D. Antonescu, Editura Medicala 2010, vol I si II Noul ghid al Societății Europene de Cardiologie (ESC) pentru managementul tromboembolismului pulmonar a fost publicat astăzi în revista European Heart Journal și prezentat în cadrul ediției 2019 a Congresului European de Cardiologie . Tromboembolismul pulmonar: „legătura primejdioasă“dintre „piciorul umflat“ şi „sufocare“ , dr. Antoniu Petriş - Ziarul de Iasi, 26.05.2016 Ghidul european de diagnostic şi tratament al emboliei pulmonare acute (versiunea 2014), Romanian Journal of Cardiology | Vol. 25, No. 1, 2015 Ades J. Les conduites alcooliques, Enciclopedie Medico - Chirurgicale, Paris, 37398 A10, 1984. Babor T, Del Boca FK (eds.) : Treatment matching in alcoholism, Cambridge Univ. Press, 2003. Edwards G, Gross MM, Keller M, Moser J, Room J. Alcohol Related Disabilities. WHO Offset Publ. No. 32, Geneva, WHO, 1977. Goodwin DW. Alcoholism and Alcoholic Psychoses, in : Kaplan HI, Sadock MD (eds) - Comprehensive Textbook of Psychiatry / IV, vol.I, Williams and Wilkins, Baltimore, 1985, pp.1016 - 1025. *** ICD - 10. Clasificarea tulburarilor mentale si de comportament. Simptomatologie si diagnostic clinic. OMS. Trad. M.Dehelean, M.Ienciu, O. Nicoara. Buc., Ed.ALL Educ., 1998. Prelipceanu D. Alcoolism, generalitati, in : Gorgos C. (ed.) - Dictionar Enciclopedic de Psihiatrie, vol.I, Bucuresti, Ed. Medicala, 1987. Schuckit MA. Alcohol - related disorders, in : Sadock BJ, Sadock VA, Ruiz P (eds.) Kaplan & Sadock s Comprehensive Textbook of Psihiatry, 9 - th ed. Wolters Kluwer / Lippincott Williams & Wilkins, 2009, vol I, 1268 - 1288. Satel SL, Kosten TR, Schuckit MA, Fischman MW. Should protracted withdrawal from drugs be included in DSM – IV. Am.J.of Psychiatry, 1993, 150, 695 - 704. Vrasti R. Alcoolismul. Detectie, diagnostic si evaluare, Timisoara, Ed. Timpolis, 2001. Perioperative Management of the Orthopaedic Patient and Alcohol Use, Abuse, and Withdrawal, Zamorano, David P. MD; Lim, Philip K. MD; Haghverdian, Brandon A. MD; Gupta, Ranjan MD, Journal of the American Academy of Orthopaedic Surgeons: March 15, 2019 - Volume 27 - Issue 6 - p e249-e257 Blake RB, Brinker MR, Ursic CM, Clark JM, Cox DD: Alcohol and drug use in adult patients with musculoskeletal injuries. Am J Orthop (Belle Mead NJ) 1997; 26:704-709. Tønnesen H, Pedersen A, Jensen MR, Møller A, Madsen JC: Ankle fractures and alcoholism: The influence of alcoholism on morbidity after malleolar fractures. J Bone Joint Surg Br 1991; 73:511-513. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1369914","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":84781043,"identity":"bd3c3397-6e72-48ce-82c1-e74dc096d41c","order_by":0,"name":"Virginia 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Moldova is one of the richest in the vineyards, especially the south of Moldova. Each peasant has a few acres of vines nearby his house and the works them every year, the land producing hundreds of liters of the wine and the \u0026laquo; tuica \u0026raquo; (Romanian spirit drink), which he consumes for his own interest.\u003c/p\u003e \u003cp\u003eIn a 24-hour shift we medically examine about the 40 patients with various acute and chronic traumatic conditions. Of these, patients at least 3 patients besides acute traumatic conditions show the specific alcoholic facies accompanied by the alcoholic restlessness and tremor that occurs in a person who has not administered his daily dose of alcohol.\u003c/p\u003e \u003cp\u003eFortunately for us, many of them have acute traumatic conditions that can be treated orthopedically and do not require hospitalization. On the other hand, at the periodic check-up, if they present themselves, they often come with the degraded plaster casts and make from the simple fractures without the displacement, the complex fractures with the secondary degradation and requiring surgery sometimes even with skin lesions due to non-compliance to the therapeutic indications.\u003c/p\u003e \u003cp\u003eIf we are talking about the lower limb, they come to the outpatient check-up stepping on the plaster devices or they remove them at home for certain reasons, as well as in the case of fractures of the upper limb, most of the times, they come with the degraded or even removed plaster cast.\u003c/p\u003e \u003cp\u003eOn a weekly basis, we have at least 2 patients of the admitted patients who trigger an alcohol withdrawal in the first 48 hours after admission, which leads us, to delay surgery, requesting the transfer to the psychiatric hospital for the psychomotor stabilization and the specialized treatment and then the patients returned for orthopedic surgical treatment.\u003c/p\u003e"},{"header":"Introduction:","content":"\u003cp\u003eThe study was conducted over a 5-year period (2015\u0026ndash;2019), on a cohort of 510 patients admitted and operated for various fractures of the upper or lower limb in the Orthopedics and Traumatology clinical department of the Emergency Clinical Hospital \"Sf. Andrei\" of Galati, who have triggered alcohol with drawl during hospitalization.\u003c/p\u003e \u003cp\u003eOf the 510 patients admitted, 215patients had different types of fractures of the upper limb and the remaining 295 patients had different types of fractures of the lower limb and fractures of the pelvis. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e "},{"header":"The Study Presentation:","content":"\u003cp\u003eThe structure of the study group is as follows 435 patients were male and 75 patients were female. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eThe vast majority of them came from the rural areas, 422 patients. In terms of education, the 35 patients had higher education, the 411 patients had secondary education and the 74 patients had elementary or no education. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe patients who presented the withdrawal syndrome were those whose age range was between 40\u0026ndash;50 -year-old (131 patients) and between 51\u0026ndash;60 -year-old (203 patients).\u003c/p\u003e\n\u003cp\u003eI should mention that 88 of the patients were consumers of alcoholic be averages (spirit drink), 245 of the patients were consumers of wine, the 99 patients were the consumers of beer and 78 patients were the consumers of any alcoholic beverage. Of the 105 patients who developed alcohol withdrawal in the first 48 hours, 35 patients were the drinkers of anything, 46 patients were the wine drinkers and 24 patients were the beer drinkers. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eDue to the rapid onset of the withdrawal syndrome to the 105 patients, we were able to perform emergency surgery on 45 patients, while the remaining 65 patients developed early alcohol withdrawal, which required a delay in surgery, a temporary immobilization of the fracture and the subsequent transfer to the psychiatric hospital for specialized treatment. Of the 65 patients who were transferred, the 30 patients had fractures where the temporary immobilization could be performed. Of the 30 patients who were immobilized in different types of plaster casts, the 15 patients returned with damaged plaster casts or even without immobilization of plaster cast.\u003c/p\u003e\n\u003cp\u003eOut of the total number of patients admitted, 405 patients underwent specialist treatment in the ward, these patients developed a milder form of the withdrawal syndrome 60 patients received variable doses of alcohol during admission in the hospital to avoid the onset of withdrawal and 20patients of them developed a milder form of the withdrawal syndrome which recovered in the first 24 hours under drug treatment, hydro electrolytic rebalancing and vitamin therapy, anticonvulsants, adrenergic, anesthetic and sometimes antipsychotic medication.\u003c/p\u003e\n\u003cp\u003eThe treatment of the alcohol withdrawal syndrome is complex, both because of the associated co morbidities and the unpredictable evolution that characterizes this syndrome. Although international guidelines recommend pharmacological treatment not only as a solution to alleviate the withdrawal syndrome but also to prevent its evolution, this treatment is in some cases ineffective with disastrous effects for the patient both pre and post-operatively [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe aim of the present work is to evaluate the evolution of patients with different types of fractures who develop the alcohol withdrawal syndrome during hospitalization as well as the complications that may occur due to the unpredictable evolution of this syndrome.\u003c/p\u003e\n\u003cp\u003eOut of 215 patients with the fractures of the upper limb, in the first 48 h after admission, 25 patients suffered complications due to the withdrawal syndrome, such as: the 20 patients with the secondary fracture opening; the 4 patients immobilized in plaster casts, had a secondary fracture degradation under plaster casts and the hemorrhagic phlebitis; 1 patient was associated nerve damage. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe most complications were encountered to the patients with the fractures of the lower limb and the pelvis who, due to the personality disorders and the alcoholic dementia, tried to mobilize on the fractured lower limb segment.\u003c/p\u003e\n\u003cp\u003eThe 295 patients had such as: the 15 patients had femoral neck fractures, the 163 patients had per trochanteric fractures, the 11 patients had femur fracture, the 37 patients had calf fractures, the 43 patients had ankle fractures, the 12 patients had pelvic fractures, the 14patients had calcaneus fractures.\u003c/p\u003e\n\u003cp\u003eOf the 295 patients, the 65patients suffered various complications, namely:20 patients had a fracture degradation and the secondary hemorrhagic blister; 20 patients suffered skin complications under immobilization with a gypsum cast.\u003c/p\u003e\n\u003cp\u003e10 of these patients had a closed fracture transformed into an open fracture, (I mention the fracture of the both lower 1/3 leg bones, where initially, a trans calcaneal traction extension was fitted to release the fracture site. Subsequently, those patients developed the hallucinatory syndromes, the alcoholic tremor, the psychomotor agitation, which is why the extension was removed and femoral-pedal immobilization was applied so that they could be transported to the psychiatric department until stabilization and hydro electrolytic balancing. On return, they presented the skin necrosis at the fracture site with the secondary fracture opening) [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. Out of all patients: 6 patients had a fracture and the secondary dislocation; 4 patients had the deep vein thrombosis; 3 patients had the pulmonary thromboembolism; 2 patients had the compartment syndrome.\u003c/p\u003e\n\u003cp\u003eIn the vast majority of cases, the withdrawal started within 48 hours of admission and of the 65 patients transferred to the psychiatric hospital, only 45 patients could be operated on before the withdrawal declined and then sent to the psychiatric department for stabilization and the other 20 patients were operated on upon return to the orthopedic department.\u003c/p\u003e\n\u003cp\u003eThe patients who could be operated on before the onset of withdrawal were additionally immobilized with a gypsum immobilizer for surgical safety and to avoid damage to the fracture as well as to the implant.\u003c/p\u003e\n\u003cp\u003eOf the 45 patients operated on in the first 48 hours, 20 patients were mobilized postoperatively after admission and loaded on the operated limb, which led to fracture and osteosynthesis material degradation, requiring reoperation.\u003c/p\u003e\n\u003cp\u003eOf the 20 patients not operated on and transferred to the psychiatric hospital (Fig.\u0026nbsp;7): 10 patients returned with fracture degradation and secondary phlyctena, which required in the first phase treatment of the phlyctena(blisters) until stripping and later definitive surgery; 4 patients with secondary open fracture, which meant during 1 surgery (first operative time) provisional until tissue healing and during II definitive surgery; 4 patients with deep vein thrombosis.\u003c/p\u003e\n\u003cp\u003eOf the 405 patients treated in the ward, 10 patients developed the secondary bleeding phlebitis, 5 patients had the deep vein thrombosis, 3 patients had the compartment syndrome, 3 patients developed the pulmonary thromboembolism and 7 patients converted a closed fracture to an open fracture. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eOf the 60 patients who received variable doses of alcohol during hospitalization, only 15 patients suffered complications, namely 4 patients had the deep vein thrombosis, 1 patient had the compartment syndrome, 2 patients had the pulmonary embolism and 8 patients had the secondary phlebitis.\u003c/p\u003e\n\u003cp\u003eIt should be noted that none of the 35 patients with the higher education had only the alcohol withdrawal syndrome. Those patients had not a withdrawal syndrome with personality disorder and they didn\u0026rsquo;t need requiring transfer to the psychiatric service. They were given alcohol in small doses, either 50 ml alcohol/day or one glass of wine/day. 11 patients refused alcohol after the first day, and they overcame the withdrawal period with hydration medication and vitamin therapy (4 ampoules of vitamin B1 and B6 intravenous daily).\u003c/p\u003e"},{"header":"Discussion:","content":"\u003cp\u003eA study conducted in March 2019 called \"Perioperative Management of the Orthopedic Patient and Alcohol Use, Abuse, and Withdrawal,\" published in the Journal of the AAOS reports that the acute and the chronic alcohol use is a significant risk factor for orthopedic conditions and postoperative complications. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eReturning to our study, we note that the alcohol withdrawal syndrome generally starts about 48 hours after the abstinence and depends on the social class, the age and type of the alcohol consumed by the patient. The most severe withdrawals syndrome was to the patients of the 51\u0026ndash;60 age groups, from the rural areas with the elementary education and to the wine and the beer drinkers. This is compounded by poor nutrition. The patients who triggered a milder withdrawal syndrome were those with higher education, well-nourished, mainly consumers of the beer or the wine. They came out of the withdrawal syndrome relatively easily, either with less alcohol consumption or with vitamin therapy and did not require transfer to a psychiatric ward. At the opposite end of the spectrum are patients aged about 50\u0026ndash;60 years, from the rural areas, who drink wine or beer, daily, in quantities of 2\u0026ndash;3 liters per day, without much education.\u003c/p\u003e \u003cp\u003eThe patients with fractures of the upper limb had fewer complications, because they could be operated on even after balancing their personality. In contrast, those with fractures of the lower limbs, especially the unoperated ones, needed more laborious surgery because of the degeneration of the fracture during the withdrawal syndrome. The patients to whom, the osteosynthesis was successful before the withdrawal syndrome, in particularly, osteosynthesis of femur and calf fractures with centromedullary implants, also progressed well after the psychotic incidents and did not require further surgery.\u003c/p\u003e \u003cp\u003eAn early mobilization of the patient with the psychomotor decompensation leads to complication of an unoperated fracture, especially in the lower limb. The choice of the implant is very important. If surgery is performed before the onset of the psychomotor agitation, osteosynthesis should preferably be centromedullary, to allow eventual loading.\u003c/p\u003e \u003cp\u003eA patient who will go to the withdrawal syndrome has obvious changes such as: the psychomotor agitation, the sweating, bradycardia, the slurred speech. In addition to this, the anamnesis must include the following questions: \u0026laquo; How much you drink per day? What you drink? When you drink? When you last drank? \u0026raquo; The patient's condition, the complete history, can direct the doctor towards to a possible crisis that must be alleviated by rapid medication - diazepam to every 2 hours, vitamin therapy in intravenous infusion (4 vials of vitamin B1 and B6), hydration and the psychotropic medication and if the patient's condition allows, firm osteosynthesis of the fracture.\u003c/p\u003e \u003cp\u003eTo the patients with fractures of the both upper and lower limbs where the fracture had degraded under the plaster cast and the secondary appearance of haemorrhagic phyllodes, daily grooming of the phyllodes was initiated. The necrectomy where necessary and their decapitation until healing after which definitive osteosynthesis was performed.\u003c/p\u003e \u003cp\u003eThe patients who suffered closed fractures with the secondary opening, benefited from a longer period of hospitalization concomitant with a surgical treatment in several stages, in the first stage was carried out the sanitization of the infectious focus by repeated cultures and targeted antibiotic therapy associated with a provisional osteosynthesis at a distance with external fixture or \"k\" brose, and then definitive osteosynthesis.\u003c/p\u003e \u003cp\u003eOf the 3 patients who developed pulmonary thromboembolism, 2 patients of them developed this condition before surgery and one patient, postoperatively. In all cases, double dose the antithrombotic and prophylaxis was initiated followed by maintenance dose.\u003c/p\u003e \u003cp\u003eThe deep venous thrombosis, which can often manifest itself by an increase in the volume of the calf, the oedema, the redness and the tenderness in the calf, can always lead to the pulmonary thrombembolism. Through the migration of an embolus of a thrombotic nature, a blood clot, the most frequently coming from the deep veins of the lower limb or pelvis, which can reach the pulmonary arteries. This frequently occurs in patients with fractures of the lower limb or in patients who are bedridden for a prolonged period of time, plus associated co morbidities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe compartment syndrome of the 2 patients analyzed occurred after a high-intensity crush injury, where emergency intervention was performed to relieve intracompartmental pressure by the fasciotomy, administration of the crystalloid solutions until it subsided. Then the surgical intervention for osteosynthesis of the fracture was done.\u003c/p\u003e"},{"header":"Conclusion:","content":"\u003cp\u003eThe patients with the possible decompensation through the alcohol withdrawal syndrome should be diagnosed at admission to the hospital and they must be treated early with the metabolic support, the vitamin therapy and the hypnotics. Also that they didn\u0026rsquo;t trigger of the alcohol withdrawal syndrome.\u003c/p\u003e \u003cp\u003eThe alcohol withdrawal syndrome is a dreaded complication of the patients, which develops through the secondary degradation of the simple fractures, by association with the vascular-nervous lesions, the pulmonary thrombembolism and in some cases, even, an osteomyelitis.\u003c/p\u003e \u003cp\u003eIn some cases, the delay of surgery, due to the early onset of the withdrawal syndrome, the surgical evolution and the long-term functional results have shown to be unsatisfactory for the patient.\u003c/p\u003e \u003cp\u003eThe correct surgical, and the especially centromedullary fracture, the resolution within the first 48 h after admission of the patients to the hospital who may develop the alcohol withdrawal syndrome, the metabolic support seems to be the optimal solution to decrease the complication rate of these patients.\u003c/p\u003e"},{"header":"Declarations:","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have revised the article critically for important intellectual content and agreed to the published version of manuscript; they also agreed be accountable for all aspects of this work in ensuring that questions related to the accuracy or integrity of any part of work are appropriately investigated and resolved such as:\u003c/p\u003e\n\u003cp\u003eV.M.\u0026ndash;wrote the article and processed the pictures; corresponding author: [email protected]\u003c/p\u003e\n\u003cp\u003eF.D. collected the data and he supervised and treated some of the patients from the study group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration of research studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a research study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of \u0026ldquo;Sf. Apostol Andrei\u0026rdquo; Clinical Emergency Hospital, Galaţi, Romania. (Project identification code : 67/January, 07, 2021).\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewritten informed consent has been obtained from patient to publish this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003einformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there it is not conflict of interest regarding the publication of this article.\u003c/p\u003e"},{"header":"References:","content":"\u003col\u003e\n \u003cli\u003eCampbell\u0026rsquo;s Operative Orthopedics 13th edition Elsevier 2017\u003c/li\u003e\n \u003cli\u003eRockwood and Green\u0026rsquo;s Fractures in Adults Lippincott Williams \u0026amp; Wilkins 2010\u003c/li\u003e\n \u003cli\u003eCompendiul de ortopedie traumatologie \u0026ndash; D. Antonescu, Editura Medicala 2010, vol I si II\u003c/li\u003e\n \u003cli\u003eNoul ghid al Societății Europene de Cardiologie (ESC) pentru managementul tromboembolismului pulmonar a fost publicat astăzi \u0026icirc;n revista European Heart Journal și prezentat \u0026icirc;n cadrul \u003ca href=\"https://www.escardio.org/Guidelines\"\u003eediției 2019 a Congresului European de Cardiologie\u003c/a\u003e\u003cem\u003e.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eTromboembolismul pulmonar: \u0026bdquo;legătura primejdioasă\u0026ldquo;dintre \u0026bdquo;piciorul umflat\u0026ldquo; şi \u0026bdquo;sufocare\u0026ldquo; , dr. Antoniu Petriş \u003cstrong\u003e-\u0026nbsp;\u003c/strong\u003eZiarul de Iasi, 26.05.2016\u003c/li\u003e\n \u003cli\u003eGhidul european de diagnostic şi tratament al emboliei pulmonare acute (versiunea 2014), Romanian Journal of Cardiology | Vol. 25, No. 1, 2015\u003c/li\u003e\n \u003cli\u003eAdes J. Les conduites alcooliques, Enciclopedie Medico - Chirurgicale, Paris, 37398 A10, 1984.\u003c/li\u003e\n \u003cli\u003eBabor T, Del Boca FK (eds.) : Treatment matching in alcoholism, Cambridge Univ. Press, 2003.\u003c/li\u003e\n \u003cli\u003eEdwards G, Gross MM, Keller M, Moser J, Room J. Alcohol Related Disabilities. WHO Offset Publ. No. 32, Geneva, WHO, 1977.\u003c/li\u003e\n \u003cli\u003eGoodwin DW. Alcoholism and Alcoholic Psychoses, in : Kaplan HI, Sadock MD (eds) - Comprehensive Textbook of Psychiatry / IV, vol.I, Williams and Wilkins, Baltimore, 1985, pp.1016 - 1025.\u003c/li\u003e\n \u003cli\u003e*** ICD - 10. Clasificarea tulburarilor mentale si de comportament. Simptomatologie si diagnostic clinic. OMS. Trad. M.Dehelean, M.Ienciu, O. Nicoara. Buc., Ed.ALL Educ., 1998.\u003c/li\u003e\n \u003cli\u003ePrelipceanu D. Alcoolism, generalitati, in : Gorgos C. (ed.) - Dictionar Enciclopedic de Psihiatrie, vol.I, Bucuresti, Ed. Medicala, 1987.\u003c/li\u003e\n \u003cli\u003eSchuckit MA. Alcohol - related disorders, in : Sadock BJ, Sadock VA, Ruiz P (eds.) Kaplan \u0026amp; Sadock s Comprehensive Textbook of Psihiatry, 9 - th ed. Wolters Kluwer / Lippincott Williams \u0026amp; Wilkins, 2009, vol I, 1268 - 1288.\u003c/li\u003e\n \u003cli\u003eSatel SL, Kosten TR, Schuckit MA, Fischman MW. Should protracted withdrawal from drugs be included in DSM \u0026ndash; IV. Am.J.of Psychiatry, 1993, 150, 695 - 704.\u003c/li\u003e\n \u003cli\u003eVrasti R. Alcoolismul. Detectie, diagnostic si evaluare, Timisoara, Ed. Timpolis, 2001.\u003c/li\u003e\n \u003cli\u003ePerioperative Management of the Orthopaedic Patient and Alcohol Use, Abuse, and Withdrawal, Zamorano, David P. MD; Lim, Philip K. MD; Haghverdian, Brandon A. MD; Gupta, Ranjan MD, Journal of the American Academy of Orthopaedic Surgeons: \u003ca href=\"https://journals.lww.com/jaaos/toc/2019/03150\"\u003eMarch 15, 2019 - Volume 27 - Issue 6 - p e249-e257\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eBlake RB, Brinker MR, Ursic CM, Clark JM, Cox DD: Alcohol and drug use in adult patients with musculoskeletal injuries. Am J Orthop (Belle Mead NJ) 1997; 26:704-709.\u003c/li\u003e\n \u003cli\u003eT\u0026oslash;nnesen H, Pedersen A, Jensen MR, M\u0026oslash;ller A, Madsen JC: Ankle fractures and alcoholism: The influence of alcoholism on morbidity after malleolar fractures. J Bone Joint Surg Br 1991; 73:511-513.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"addiction, alcohol, withdrawal, agitation, fracture","lastPublishedDoi":"10.21203/rs.3.rs-1369914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1369914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study presents the impact of alcohol addiction in the treatment of fractures following alcohol withdrawal.\u003c/p\u003e\u003cp\u003eThe study was done on patients from the region of Moldova, Romania and admitted to the orthopedics-traumatology department. \u003c/p\u003e\u003cp\u003eThe Moldavian region of Romania is famous for its wine-growing areas and the quality of its wines (internationally renowned vineyards are: Cotnari, Odobesti, Panciu Husi) and is therefore a region with high alcohol consumption. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eThe study presentation: \u003c/strong\u003eThe study carried out in the orthopaedics-traumatology clinic of the Emergency Clinical Hospital «\u0026nbsp;Sf.\u0026nbsp;Andrei\u0026nbsp;» of Galati, was conducted over a period of 5 years, 2015-2019, on a group of 510 patients. Of the 510 patients admitted, the 215 patients had different types of fractures of the upper limb and the remaining 295 patients had different types of fractures of the lower limb but also fractures of the pelvis. \u003c/p\u003e\u003cp\u003eThe welded group was composed of the follows: the 435 patients were male and the 75 female.\u003c/p\u003e\u003cp\u003eThe vast majority of these patients were from the rural areas, 422 patients.\u003c/p\u003e\u003cp\u003eIn terms of social class, the 35 patients had higher education, the 411 patients had secondary education and the 74 patients had elementary or no education. The most affected age of the patients with the withdrawal syndrome was in the 40-50 age group (131 patients) and 51-60-year-old (203 patients). 88 of the patients were spirits drinkers (especially «\u0026nbsp;ţuică\u0026nbsp;» Romanian spirit drink), 245 of the patients were the wine drinkers, 99 patients were the beer drinkers and 78 patients were the drinkers of any alcoholic beverage.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiscussions: \u003c/strong\u003eOf the 105 patients who developed sudden alcohol withdrawal in the first 48 hours, 35 patients were consumers of any type of alcoholic beverage, 46 patients were the wine drinkers and 24 were the beer drinkers.\u003c/p\u003e\u003cp\u003eDue to the rapid onset of withdrawal of the 105 patients, we were able to perform emergency surgery on only the 45 patients, while the remaining the 65 patients developed early alcohol withdrawal, which necessitated a delay in surgery, temporary immobilization of the fracture and subsequent transfer to the psychiatric hospital for the specialized treatment. Of the 65 patients who were transferred, the 30pacients had fractures where the temporary immobilization could be performed. Of the 30 patients who were immobilized in different types of plaster casts, the 15 patients returned with damaged plaster casts or even without immobilization.\u003c/p\u003e\u003cp\u003eThe alcohol withdrawal generally starts about 48 hours after the abstinence and depends by the social class, the age and the type of alcohol consumed by the patient. The most severe types of the withdrawal were to the patients 51-60 -year-old, from the rural areas with the elementary education and the consumers of wine and beer. To this is added poor nutrition. The patients who were more easily withdrawn were those with higher education, well nourished, mainly consumers of beer or wine. They came out of the withdrawal relatively easily either with less the alcohol consumption or with the vitamin therapy and did not require the transfer to a psychiatric ward. At the opposite end of the spectrum are patients about 50-60 -year-old, from rural areas, who drink 2-3 liters of wine or beer a day, without much education.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The patients with the possible decomposition through the alcohol withdrawal should be diagnosed at the admission and treated early with the metabolic support, the vitamin therapy and the hypnotics so that they do not the trigger alcohol withdrawal. In some cases, the delay of the surgery due to the early onset of the withdrawal, the long-term surgical and the functional outcomes have been shown to be unsatisfactory for the patient.\u003c/p\u003e","manuscriptTitle":"Influence of Alcohol Consumption in the Fracture Healing Process","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-02-21 15:59:47","doi":"10.21203/rs.3.rs-1369914/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c49212a-4c6b-4af8-ab7b-6e20827c7fca","owner":[],"postedDate":"February 21st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-03-16T05:24:53+00:00","versionOfRecord":[],"versionCreatedAt":"2022-02-21 15:59:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1369914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1369914","identity":"rs-1369914","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}