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Increased ankle fracture site tenderness, pain seen in chronic heavy smokers
Researchers identified a significant risk of superficial wound infection and delayed union of ankle fractures in heavy smokers.
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Open reduction and internal fixation to treat closed ankle fractures in patients who were chronic heavy smokers was associated with more postoperative problems than in an age-matched and gender-matched group of patients with these fractures who did not smoke, according to results of a recently presented study.
Waseem Jerjes, MD, PhD, a fellow, and Peter Giannoudis, MD, FRCS, a professor in the Academic Unit of Trauma and Orthopaedic Surgery at the School of Medicine at the University of Leeds, in Leeds, United Kingdom, and colleagues, identified 173 patients at their institution who presented with closed ankle fractures and met the inclusion criteria for the retrospective study during a recent 4-year period. They matched these patients to a group of 173 nonsmokers with closed ankle fractures. They classified the fractures using the Lauge-Hansen classification system and also matched the fractures in the two groups of patients by classification.
“If you are a chronic heavy smoker or not a smoker at all and you sustain an ankle fracture, when we matched these two groups by age and gender and Lauge-Hansen classification, we found that there is no significant difference in soft tissue and bone healing,” Jerjes said.
“A chronic heavy smoker is defined as a person who smokes 20 cigarettes a day and has been smoking for over 20 years,” Jerjes said.
Patients in the heavy smoking group had a mean age of 43 years; 85 patients underwent open reduction and internal fixation (ORIF) and the other patients were treated with cast immobilization for 6 weeks. By comparison, patients in the nonsmoking group had a mean age of 47 years; 78 patients in the control group underwent ORIF and the rest received the same conservative care as the smoking group.
All patients received clinical follow-up reviews and examinations at the investigators’ clinic, Jerjes said. He and his colleagues obtained a 2-year minimum follow-up on all patients.
“None of the patients had any medical conditions that would affect their bone healing ability,” Jerjes said.
Researchers found fracture healing in the smoking group was significantly delayed compared to the control group. This occurred at a mean of 16 weeks in the study group compared to 9 weeks for patients in the control group. Smokers had a greater risk of developing a superficial wound infection or a delayed union with a duration of more than 6 months, among such other problems as an extended overall fracture healing time. – by Susan M. Rapp
- Reference:
- Jerjes W. Paper #16. Presented at: International Orthopaedic Trauma Care Forum; Oct. 9, 2013; Phoenix.
- For more information:
- Waseem Jerjes, MD, PhD, can be reached at Academic Unit of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom; email: waseem_wk1@yahoo.co.uk.
- Peter Giannoudis, MD, FRCS, can be reached at Academic Unit of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom; email: pgiannoudi@aol.com.
Disclosures: Jerjes and Giannoudis have no relevant financial disclosures.