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Smoking increases risk of nonunion following fracture
Patients who smoke had a significantly increased risk of nonunion of overall fractures, tibial fractures and open fractures, according to study results.
“This review illustrates the deleterious effects of smoking on acute fractures,” the researchers wrote in the study. “A complete and thorough smoking history should be included in the evaluation of any patient with a new fracture or a fracture that demonstrates delayed or absent healing. This history should include the type of tobacco product was used as well as the frequency and duration of use.”
Researchers included 19 studies found through a search of Medline, Embase and Cochrane databases and calculated the adjusted-odds ratios and frequency-weighted means for primary and secondary outcome measures.
Results showed an increased nonunion rate in patients who smoked and had a tibial fracture, as well as patients who smoked and sustained open fractures. Patients who smoked also experienced a longer mean healing time vs. nonsmokers for all fractures, according to study results. While researchers noted trends toward more superficial and deep infections of postoperative or traumatic wounds in patients who smoked, the differences in superficial and deep infection rates were not significant.
“Future prospective clinical studies are needed to clarify whether the effects of smoking and nicotine are dose-dependent,” the researchers wrote in the study. “In addition, the increasing use of smokeless tobacco raises new questions regarding the effects of nicotine delivered through noncombustible products. Finally, studies that better delineate the impact of directed education and the effects of the timing of smoking cessation (both before and after surgery) on the perioperative complication rate are needed to provide optimal care for patients with a fracture.”
Disclosures: Ahn is a consultant for Venable LLC and Merck. Mehta is a consultant for Synthes and Smith & Nephew, received payment from the Department of Defense, Orthopaedic Trauma Association, FOT, AO North America, Zimmer and Smith & Nephew, and royalties from Wolters Kluwer. Schenker received grants from the Orthopaedic Research and Education Foundation and AO North America.