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Chronic smokers likely to experience delayed union of humerus fractures
Long-term smoking can also result in significant reduction in blood supply at the fracture site.
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Research has shown an association between cigarette smoking and delayed union of long bone fractures and osteomyelitis. In a recently presented study, investigators determined that heavy cigarette smoking negatively affected healing in patients with proximal humerus fractures treated surgically.
Peter Giannoudis, MD, FRCS, and Waseem Jerjes, MD, PhD, told Orthopaedics Today Europe chronic heavy smokers with proximal humerus fractures can suffer from delayed fracture union, a higher complication rate and other negative outcomes compared with non-smokers.
“If you are a chronic heavy smoker and require surgery for your proximal humerus fracture, the risk of developing complications including delayed fracture healing, poor wound healing, postoperative pain and deep surgical site infection is fairly high,” Giannoudis said.
Heavy smoking can impede healing
During a 5-year period, 1,752 patients were treated for proximal humerus fractures at the researchers’ institution in Leeds, United Kingdom, and 118 patients defined as heavy smokers met the criteria for the retrospective comparative study. An age and sex matched control group of 118 nonsmokers was also recruited from the patient group. Fractures in all patients were classified using the Neer classification system.
Shown is a radiograph of a 52-year-old male chronic smoker with a proximal humerus fracture.
The radiograph at 4 weeks postoperatively shows the fracture failed to unite.
Images: Giannoudis PV
According to Jerjes, heavy smoking was defined in the study as daily smoking of 20 cigarettes or more for more than 20 years.
The primary outcomes of the study included time to fracture union and wound healing. Secondary outcomes used were postoperative complications, and the incidence of delayed union and non-union.
“None of the patients included in our study had any medical conditions nor were taking any medications that would affect bone metabolism or the overall wound and bone healing process,” Jerjes said.
Smoking increased complications
Researchers found soft tissue healing was significantly delayed in the smokers cohort (6 weeks ± 2 weeks) compared to the control group (2 weeks ± 1 week). Chronic heavy smokers were also found to have delayed fracture healing compared to the non-smoking group which occurred at 11 weeks vs. 9 weeks.
According to study data, there was a significant correlation between chronic smokers and surgical site infections (P = 0.002), postoperative delayed wound healing (P = 0.01) and postoperative pain (P < 0.001).
Through 4 months postoperatively the proximal humerus fracture still failed to unite.
The radiographs at 8 months postoperatively show the fracture failed to unite.
Giannoudis and Jerjes noted the chemicals in tobacco could damage blood vessel linings and disturb the lipid levels in the blood stream. Because of that damage, pathologies can develop due to atheroma formation. They noted long-term smoking can result in significant reduction in the blood supply to the fractured area and lead to reduced oxygenation.
“This in turn may have led to delay in fracture union and poor wound healing,” they said. – by Robert Linnehan
- Reference:
- Jerjes W. Poster #165. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 16-18, 2014; Tampa, Fla., USA.
- For more information:
- Peter V. Giannoudis, FRCS, can be reached at the Academic Unit of Trauma and Orthopaedic Surgery, School of Medicine, Floor A, Clarendon Wing, LGI, Great George St., Leeds, LS1 3EX, United Kingdom; email: p.giannoudi@leeds.ac.uk.
- Waseem Jerjes, MD, PhD, can be reached at the Academic Unit of Trauma and Orthopaedic Surgery, School of Medicine, Room 10.110, Worsley Building, University of Leeds, Leeds LS2 9JT, United Kingdom; email: waseem_wk1@yahoo.co.uk.
Disclosures: Giannoudis and Jerjes report no relevant financial disclosures.